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1.
J Stroke Cerebrovasc Dis ; 28(11): 104296, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31395425

RESUMO

OBJECTIVES: This study was designed to investigate the effect of prism adaptation (PA) combined with continuous theta-burst transcranial magnetic stimulation (cTBS) on the neglect recovery of stroke patients with unilateral neglect. METHODS: A total of 14 stroke patients with unilateral neglect were randomly assigned to 2 groups including an intervention group undergone PA combined with cTBS over the left intact parietal cortex and a control group. PA combined with sham cTBS was perfomed for 2 weeks in 10 daily sessions. Before and after the intervention, patients were evaluated for visuospatial neglect measured using the Star Cancellation Test (SCT), Line Bisection Task (LBT), Figure Copying Test, and Clock Drawing Task. Neurological function was evaluated using the Modified Rankin Scale (MRS). RESULTS: Both groups (PA alone and PA+ cTBS) showed improvement in their neglected symptoms (measured by SCT, LBT, Figure Copying Test, and Clock Drawing Task), and in their disability in the neurological function (measured by MRS) (P< .05). CONCLUSIONS: The results of the present study showed that, transcranial magnetic stimulation did not increase the effect of PA on neglect symptoms in stroke patients.

2.
Anatol J Cardiol ; 22(1): 33-43, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31264654

RESUMO

OBJECTIVE: The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population. METHODS: In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index. RESULTS: Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12-1.56) and almost equally WC (1.35; 1.13-1.60) in men and WC (1.20; 1.04-1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m2 in men (1.91; 1.40-2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17-2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5-24.9 kg/m2). CONCLUSION: Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31046115

RESUMO

BACKGROUND: Physical activity is a modifiable risk factor associated with health benefits. We hypothesized that a more active lifestyle in older adults is associated with a reduced risk of incident parkinsonism and a slower rate of its progression. METHODS: Total daily physical activity was recorded with an activity monitor in 889 community-dwelling older adults participating in the Rush Memory and Aging Project. Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale and summarized as a categorical measure and continuous global parkinsonian score. We used Cox models to determine if physical activity was associated with incident parkinsonism and linear-mixed effects models to examine if physical activity was associated with the rate of progressive parkinsonism. RESULTS: During an average follow-up of four years, 233 of 682 (34%) participants, without parkinsonism, developed incident parkinsonism. In Cox models controlling for age, sex, and education, a higher level of physical activity was associated with a reduced risk of developing parkinsonism (HR = 0.79; 95% CI 0.70 - 0.88, p < 0.001). This association was not attenuated when controlling for cognition, depressive symptoms, Apolipoprotein E Ɛ4 allele, and chronic health conditions. In a linear mixed-effects model including all participants (N=889) which controlled for age, sex, and education, a 1 SD total daily physical activity was associated with a 20% slower rate of progression of parkinsonism. CONCLUSION: Older adults with a more active lifestyle have a reduced risk for parkinsonism and a slower rate of its progression.

4.
J Hum Hypertens ; 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30385824

RESUMO

A 10-year longitudinal population-based study entitled Isfahan Cohort Study (ICS) was conducted in 2001-2011 with cardiovascular disease (CVD) as the primary outcome. We considered ICS as a master plan for a multi-level non-communicable disease (NCD) study named Isfahan Cohort Study 2 (ICS2). ICS2 is a multi-generation 10-year cohort study with new goals and outcomes that have been started in 2013, recruiting a sub-sample of ICS (n = 1487) and a new recruited sample (n = 1355) aged 35 years and over, all living in urban and rural areas of two counties in central Iran. In addition, 2500 of participant's adult children were selected randomly, as well as 1000 of their grandchildren. The aim of ICS2 is to detect the incidence of some NCDs including CVD, cancers, and diabetes and to identify the impact of their behavioral, metabolic, environmental, and genetic risk factors. In addition, studying lifestyle behaviors in three generations in a hierarchical manner of parents, their children and grandchildren in ICS2 will improve our knowledge on other determinants such as epigenetics of NCDs.

5.
Acta Neuropathol ; 136(6): 887-900, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30334074

RESUMO

Alzheimer's dementia is significantly more common in women than in men. However, few pathological studies have addressed sex difference in Alzheimer's disease (AD) and other brain pathologies. We leveraged postmortem data from 1453 persons who participated in one of two longitudinal community-based studies of older adults, the Religious Orders Study and the Rush Memory and Aging Project. Postmortem examination identified AD pathologies, neocortical Lewy bodies, DNA-binding protein 43 (TDP-43), hippocampal sclerosis, gross and micro infarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. Linear and logistic regressions examined the association of sex with each of the pathologic measures. Two-thirds of subjects were women (n = 971; 67%), with a mean age at death of 89.8 (SD = 6.6) years in women and 87.3 (SD = 6.6) in men. Adjusted for age and education, women had higher levels on a global measure of AD pathology (estimate = 0.102, SE = 0.022, p < 0.001), and tau tangle density in particular (estimate = 0.334, SE = 0.074, p < 0.001), and there was a borderline difference between women and men in amyloid-ß load (estimate = 0.124, SE = 0.065, p = 0.056). In addition, compared to men, women were more likely to have more severe arteriolosclerosis (OR = 1.28, 95% CI:1.04-1.58, p = 0.018), and less likely to have gross infarcts (OR = 0.78, 95% CI:0.61-0.98, p = 0.037), although the association with gross infarct was attenuated after controlling for vascular risk factors. These data help elucidate the neuropathologic footprint of sex difference in AD and other common brain pathologies of aging.

6.
Lancet ; 391(10134): 2019-2027, 2018 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-29864018

RESUMO

BACKGROUND: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. METHODS: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. FINDINGS: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics. INTERPRETATION: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. FUNDING: Chest, Heart and Stroke Scotland.


Assuntos
Padrões de Prática Médica , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Casos e Controles , Países Desenvolvidos , Países em Desenvolvimento , Medicina Baseada em Evidências , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Pobreza , Inquéritos e Questionários , Análise de Sobrevida , Resultado do Tratamento
7.
Neurology ; 90(24): e2127-e2134, 2018 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-29752306

RESUMO

OBJECTIVE: To examine the association of the APOE ε2ε4 genotype with incident Alzheimer disease (AD), mild cognitive impairment (MCI), cognitive decline, and AD pathology in older adults. METHODS: We used data from 2,151 older adults of European ancestry who were free of dementia at baseline and underwent structured annual clinical evaluation in a longitudinal study for incident AD and MCI, and cognitive decline. Postmortem examination in decedents documented pathologic AD and quantified ß-amyloid and neurofibrillary tangles. Participants were stratified into 4 groups based on APOE genotyping: ε2ε4, ε4 (ε4ε4, ε4ε3), ε2 (ε2ε2, ε2ε3), with ε3ε3 carriers serving as the reference group. We used Cox proportional hazards models to examine the association of APOE genotype with incident AD and MCI. Linear mixed-effect models were used to examine the association with cognitive decline. Logistic and linear regression models were used to examine AD pathology. All the models controlled for age, sex, and education. RESULTS: Of the 2,151 participants included in this study, ε2ε4 accounted for 2.1%, ε3/4 and 4/4 21.8%, ε2/3 and 2/2 14.0%, and ε3ε3 62.1%. We did not observe a difference in the risk of AD for ε2ε4 compared to ε3ε3. In cases without cognitive impairment at baseline, ε2ε4 carriers had an increased risk of incident MCI (hazard ratio 2.13, 95% confidence interval 1.34-3.39, p = 0.002) and a faster rate of cognitive decline (estimate -0.047, SE 0.018, p = 0.008) compared to ε3ε3 carriers. In decedents (n = 1,100), ε2ε4 showed a 3-fold increased odds of pathologic AD and a higher ß-amyloid load than ε3ε3. CONCLUSION: APOE ε2ε4 genotype in older adults is associated with risk of MCI, cognitive decline, and a greater burden of AD pathology, especially ß-amyloid.

8.
J Clin Neuromuscul Dis ; 19(4): 203-210, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29794575

RESUMO

OBJECTIVES: Glycogen storage disease type 3 (GSD-III) is a rare inherited metabolic disorder caused by glycogen debranching enzyme deficiency. Various pathogenic mutations of the AGL gene lead to abnormal accumulation of glycogen in liver, skeletal, and cardiac muscles. Here, we report distinct clinical and genetic data of Iranian patients with GSD-III. METHODS: Clinical and laboratory data of 5 patients with GSD-III were recorded. Genetic investigation was performed to identify the causative mutations. RESULTS: Three patients had typical liver involvement in childhood and one was diagnosed 2 years after liver transplantation for cirrhosis of unknown etiology. Four patients had vacuolar myopathy with glycogen excess in muscle biopsy. All patients had novel homozygous mutations of the AGL gene namely c.378T>A, c.3295T>C, c.3777G>A, c.2002-2A>G, and c.1183C>T. CONCLUSIONS: This is the first comprehensive report of patients with GSD-III in Iran with 2 uncommon clinical presentations and 5 novel mutations in the AGL gene.


Assuntos
Doença de Depósito de Glicogênio Tipo III , Glicogênio/genética , Mutação/genética , Adolescente , Adulto , Feminino , Glicogênio/metabolismo , Sistema da Enzima Desramificadora do Glicogênio/genética , Doença de Depósito de Glicogênio Tipo III/genética , Doença de Depósito de Glicogênio Tipo III/fisiopatologia , Doença de Depósito de Glicogênio Tipo III/cirurgia , Doença de Depósito de Glicogênio Tipo III/terapia , Humanos , Irã (Geográfico)/epidemiologia , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Adulto Jovem
9.
Metab Syndr Relat Disord ; 16(3): 127-134, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29437523

RESUMO

BACKGROUND: There is still a controversy about the causal relationship between menopause status and cardiovascular disease (CVD). The present study aimed to evaluate whether premature menopause would predict higher risk and lower the age of CVD occurrence and how this differs in women with metabolic syndrome (MetS). METHODS: Using a population-based Isfahan Cohort Study (ICS), 1154 postmenopause women were followed up from 2001 to 2013 for any CVD occurrence. Cox proportional hazards regression analyses were used to estimate the association between menopause age of (≤45, 46-50, 51-55, ≥56 years) and CVD incidence. The menopause age group of 46-50 years was considered as reference group. RESULTS: During 12 years follow-up, 235 CV events were recorded. The mean age of menopause (±standard deviation) was 48.06 ± 5.48 years. The age at menopause was not predictive of total CV events, in women with and without MetS. In women without MetS, a trend with increasing incidence of stroke was observed at menopause age of ≤45 years (age adjusted hazard ratio: 4.84, 95% confidence interval: 0.99-23.5, P = 0.05). Women with menopause age of ≤45 years suffered from CV events, 5.7 years earlier than women with menopause age of ≥56 years (P = 0.11); this difference was 5.3 years in women with MetS (P = 0.4). CONCLUSION: This study showed that younger age at menopause is not predictive of the occurrence of CV events. It also revealed that age at menopause is not associated with earlier CV events in postmenopause women, with and without MetS.

11.
J Stroke Cerebrovasc Dis ; 27(1): 185-191, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28893574

RESUMO

BACKGROUND: Two previous studies, which investigated transcranial direct current stimulation (tDCS) use in motor recovery after acute ischemic stroke, did not show tDCS to be effective in this regard. We speculated that additional left dorsolateral prefrontal cortex (DLPFC) stimulation may enhance poststroke motor recovery. METHODS: In the present randomized clinical trial, 20 acute ischemic stroke patients were recruited. Patients received real motor cortex (M1) stimulation in both arms of the trial. The 2 arms differed in terms of real versus sham stimulation over the left DLPFC. The motor component of the Fugl-Meyer upper extremity assessment (FM) and Action Research Arm Test (ARAT) scores were used to assess primary outcomes, and nonlinear mixed effects models were used for data analyses. RESULTS: Primary outcome measures improved more and faster among the real stimulation group. During the first days of stimulations, the sham group's FM scores increased by 1.2 per day, while the real group's scores increased by 1.7 per day (P = .003). In the following days, FM improvement decelerated in both groups. Based on the derived models, a stroke patient with a baseline FM score of 15 improves to 32 in the sham stimulation group and to 41 in the real stimulation group within the first month after stroke. Models with ARAT scores yielded nearly similar results. No significant adverse effect was reported. CONCLUSION: The current study results showed that left DLPFC stimulation in conjunction with M1 stimulation resulted in better motor recovery than M1 stimulation alone.


Assuntos
Isquemia Encefálica/reabilitação , Atividade Motora , Córtex Pré-Frontal/fisiopatologia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Extremidade Superior/inervação , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Dinâmica não Linear , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Resultado do Tratamento
12.
PLoS One ; 12(12): e0189389, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29261727

RESUMO

This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a population-based prospective study of 6504 Iranian adults ≥35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statistics such as area under the receiver-operating characteristic (AUROC), calibration chi-square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell's C indices were 0.74 (95% CI, 0.72-0.76) and 0.73, respectively. In the calibration, the Nam-D'Agostino χ2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In comparison, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well-calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management.


Assuntos
Doenças Cardiovasculares/epidemiologia , Medição de Risco , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Região do Mediterrâneo/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Relação Cintura-Quadril
13.
Eur J Nutr ; 2017 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-29151136

RESUMO

BACKGROUND: The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population. METHODS: We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders. RESULTS: During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29). CONCLUSIONS: Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.

14.
J Cardiovasc Thorac Res ; 9(3): 158-163, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29118949

RESUMO

Introduction: As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women. Methods: Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke. Results: After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively). Conclusion: In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.

15.
Stroke ; 48(8): 2263-2265, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28679849

RESUMO

BACKGROUND AND PURPOSE: Mendelian strokes are rare genetic disorders characterized by early-onset small-vessel stroke. Although extensively studied among families with syndromic features, whether these genes affect risk among sporadic cases is unknown. METHODS: We sequenced 8 genes responsible for Mendelian stroke in a case-control study of sporadic stroke cases (≤70 years). Participants included 1251 primary stroke cases of small-vessel pathology (637 intracerebral hemorrhage and 614 small-vessel ischemic stroke cases) and 1716 controls from the INTERSTROKE study (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World). RESULTS: Overall, the prevalence of canonical disease-causing mutations was 0.56% in cases and 0.23% in controls (odds ratio=1.89; 95% confidence interval, 0.54-7.57; P=0.33). CADASIL (Cerebral Autosomal Dominant Arteriopathies with Subcortical Infarcts and Leukoencephalopathies) mutations were more frequent among cases (0.48%) than controls (0.23%) but were not significantly associated with stroke risk (odds ratio=2.03; 95% confidence interval, 0.58-8.02; P=0.27). Next, we included all rare nonsynonymous mutations to investigate whether other types of mutations may contribute to stroke risk. Overall, 13.5% of cases and 14.2% of controls were carriers of at least one rare nonsynonymous mutation among the 8 Mendelian stroke genes. Mutation carriers were not at elevated risk of stroke (odds ratio=0.93; 95% confidence interval, 0.75-1.16; P=0.55). CONCLUSIONS: In the absence of syndromic features and family history of stroke, screening for Mendelian mutations among small-vessel stroke patients is unlikely to have high diagnostic utility.


Assuntos
CADASIL/genética , Hemorragia Cerebral/genética , Predisposição Genética para Doença/genética , Acidente Vascular Cerebral/genética , Idoso , CADASIL/diagnóstico , Estudos de Casos e Controles , Hemorragia Cerebral/diagnóstico , Feminino , Humanos , Masculino , Microvasos/patologia , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico
16.
Metab Syndr Relat Disord ; 15(7): 354-362, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28677982

RESUMO

BACKGROUND: To identify the associated risk factors with development of metabolic syndrome (MetS) in a longitudinal prospective cohort study in an Iranian population. METHODS: A total of 1994 participants, aged ≥35 years, free of MetS, diabetes, and cardiovascular disease at baseline were followed up for 7 years. Physical examination, laboratory studies, and interview about lifestyle factors were performed, and MetS was defined based on harmonized definition at both time points. Logistic regression was used to calculate odds ratio (OR) and corresponding 95% confidence interval (CI). RESULTS: MetS occurred in 27% of subjects with an incidence rate of 39.2 and 46.6 per 1000 person-year in men and women, respectively (P = 0.04). Among the components of MetS, triglyceride (TG) alone (OR 2.59, 95% CI 1.78-3.78) or in combination with waist circumference (WC; OR 5.01, 95% CI 3.59-7.01) was the strongest predictor of incident MetS compared to those free of components. In multivariable analysis, all components were associated with higher risk except fasting plasma glucose in both genders and high-density lipoprotein cholesterol in men. Impaired glucose tolerance was associated with two (95% CI 1.11-3.65) times increased risk in women. The multivariable adjusted OR (95% CI) of overweight and obesity was 1.68 (1.13-2.50) and 2.88 (1.73-4.78) in women and 2.46 (1.74-3.46) and 2.47 (1.38-4.43) in men, respectively. Unhealthy diet [1.57 (1.02-2.41)] and weekly Cola consumption [1.50 (1.05, 2.14)] increased the risk in women only. CONCLUSIONS: TG and WC components showed the highest predictive values for MetS incidence, while general obesity was independently associated with it.


Assuntos
Síndrome Metabólica/etnologia , Síndrome Metabólica/metabolismo , Triglicerídeos/sangue , Circunferência da Cintura , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Estudos de Coortes , Complicações do Diabetes/diagnóstico , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio , Análise Multivariada , Obesidade/complicações , Razão de Chances , Sobrepeso , Estudos Prospectivos , Análise de Regressão , Fatores de Risco
17.
J Stroke Cerebrovasc Dis ; 26(2): 286-294, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27769610

RESUMO

BACKGROUND: Metabolic syndrome (MetS) is recently proposed as a predictor for the occurrence of vascular defects causing ischemic stroke. However, details on the association of MetS with stroke are scare in our region. The present study aimed to assess the predictive value of MetS and its components for stoke among the Iranian population. METHODS: A longitudinal population-based study was conducted on adults aged 35 years or older who were living in 3 districts in central part of Iran and followed for 10 years. Stroke was diagnosed using World Health Organization guidelines, and MetS was defined according to the Adult Treatment Panel-III definition. RESULTS: Among the 5398 subjects, 2021 suffered from MetS with an incidence of 37.4%. The incidence rates of stroke in those with and without MetS were 2.6% and 1.1%, respectively, with a higher significance in the former group (P = .026). Compared to the controls, participants with stroke exhibited a higher prevalence of some components of MetS including hyperglycemia and hypertension. On Cox proportional hazard analysis, the hazard ratio for a long-term risk of ischemic stroke was 1.37 overall (95% confidence interval: 1.15-1.63, P < .001) in subjects with MetS. Considering different components of MetS, hyperglycemia (hazard ratio = 1.83, P = .011) and hypertension (1.74, P = .019) could effectively predict occurrence of long-term ischemic stroke. CONCLUSION: MetS and its main components can be potent predictors for long-term ischemic stroke. Thus, the focus should be on identification and appropriate control of MetS components to prevent stroke occurrence.


Assuntos
Isquemia Encefálica/epidemiologia , Síndrome Metabólica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Risco , Fatores de Risco
19.
Iran J Neurol ; 16(4): 201-209, 2017 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-29736226

RESUMO

Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate the 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran. Methods: In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke (IS) subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH)] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke. Results: The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001]. Conclusion: Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.

20.
J Neurol Sci ; 370: 107-111, 2016 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-27772737

RESUMO

OBJECTIVES: Methamphetamine use is a strong risk factor for stroke. This study was designed to evaluate arterial function and structure in methamphetamine users ultrasonographically. METHODS: In a cross-sectional study, 20 methamphetamine users and 21 controls, aged between 20 and 40years, were enrolled. Common carotid artery intima-media thickness (CCA-IMT) marker of early atherogenesis, flow-mediated dilatation (FMD) determinants of endothelium-dependent vasodilation, and nitroglycerine-mediated dilatation (NMD) independent marker of vasodilation were measured in two groups. RESULTS: There were no significant differences between the two groups regarding demographic and metabolic characteristics. The mean (±SD) CCA-IMT in methamphetamine users was 0.58±0.09mm, versus 0.59±0.07mm in the controls (p=0.84). Likewise, FMD% was not significantly different between the two groups [7.6±6.1% in methamphetamine users vs. 8.2±5.1% in the controls; p=0.72], nor were peak flow and shear rate after hyperemia. However, NMD% was considerably decreased in the methamphetamine users [8.5±7.8% in methamphetamine users vs. 13.4±6.2% in controls; p=0.03]. CONCLUSION: According to our results, NMD is reduced among otherwise healthy methamphetamine users, which represents smooth muscle dysfunction in this group. This may contribute to the high risk of stroke among methamphetamine users.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/fisiopatologia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Metanfetamina/efeitos adversos , Miócitos de Músculo Liso/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/diagnóstico por imagem , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/efeitos dos fármacos , Artéria Carótida Primitiva/fisiopatologia , Espessura Intima-Media Carotídea , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estudos Transversais , Humanos , Masculino , Metanfetamina/administração & dosagem , Miócitos de Músculo Liso/fisiologia , Nitroglicerina , Vasodilatação/fisiologia , Vasodilatadores , Adulto Jovem
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