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1.
Eur J Med Res ; 27(1): 109, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35781348

RESUMO

OBJECTIVE: Based on the social-ecological model, this study aimed to comprehensively explore factors affecting the risk of ischemic cerebrovascular disease (ICVD) in postmenopausal women to provide theoretical bases for further prevention and intervention for postmenopausal women. METHODS: Postmenopausal women who underwent medical examinations in one health-checkup agency in Tianjin from May 2015 to October 2015 were enrolled in this study. The ICVD 10-year Risk Assesment Form developed by the research team of the National "Tenth Five-Year Plan" research project was used to assess the factors affecting the risk of ICVD. Based on the social-ecological model, multiple types of scales, including physical activities, depression, Type D personality, social supports, and environment score, were used to comprehensively explore the factors associated with ICVD in postmenopausal women. RESULTS: 300 valid questionnaires were obtained, with an effective rate of 92.0%. The subjects aged 44-74 years, with the average age of 62.06 ± 7.09 years. Among them, 58.67% of the subjects only obtained high-school diploma, 32.67% obtained college or university diploma, 90.33% were retirees, 95.33% were married, 92.33% experienced the natural menopause, 93.33% lived in urban or suburban areas, and 1.00% had a history of breast cancer. Multivariate logistic regression analysis suggested that monthly income (¥), parity, exposure to second-hand or third-hand smoke, easy access to healthy food, physical activities, depression, Type D personality, social support and environmental factors were associated with the risk of ICVD in postmenopausal women (P < 0.05). Among them, easy access to healthy food (OR = 0.242), social support (OR = 0.861) and environmental factors (OR = 0.866) were protective factors from ICVD. OR < 1 indicates that the exposure factor is negatively correlated with the disease, and the exposure factor has a protective effect on preventing the occurrence of the disease. Parity (OR = 3.795), exposure to second-hand or third-hand smoke (OR = 2.886), depression (OR = 1.193), and Type D personality (OR = 1.148) were risk factors of ICVD. OR > 1 means that the exposure factor is positively correlated with the disease, and the exposure factor increases the risk of disease occurrence. CONCLUSIONS: For postmenopausal women, in the future, in addition to prevention and management of the conventional risks, the conditions of their mentality and social support should be paid attention to, at the same time, and if they can, try to choose a good community environment to live in, which could better reduce the incidence and mortality of ICVD in postmenopausal women.


Assuntos
Transtornos Cerebrovasculares , Poluição por Fumaça de Tabaco , Idoso , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Exercício Físico , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Gravidez , Fatores de Risco
2.
Cien Saude Colet ; 27(8): 3295-3306, 2022 Aug.
Artigo em Português, Inglês | MEDLINE | ID: mdl-35894339

RESUMO

Cerebrovascular diseases (CVD) are one of the leading causes of mortality globally. Air temperature is one of the risk factors for CVD; however, few studies have investigated the relationship between air temperature and mortality from these diseases in Brazil. This time series study investigated the relationship between air temperature and CVD mortality in 10 microregions located across Brazil's five regions during the period 1996 to 2017 using mortality data from the national health information system, DATASUS and daily mean temperature data. The association between mean air temperature and mortality from CVD was measured using generalized additive models with Poisson distribution and relative and attributable risks were estimated together with 95% confidence intervals using distributed lag non-linear models and a 14-day lag. There were 531,733 deaths from CVD during the study period, 21,220 of which (11,138-30,546) were attributable to air temperature. Minimum mortality temperatures ranged from 20.1ºC in Curitiba to 29.6ºC in Belém. Associations between suboptimal air temperatures and increased risk of death from CVD were observed in all of Brazil's five regions. Relative risk from the cold was highest in Manaus (RR 1.53; 1.22-1.91) and Campo Grande (RR 1.52; 1.18-1.94), while relative risk from heat was highest in Manaus (RR 1.75; 1.35-2.26) and Brasília (RR 1.36; 1.15-1.60).


As doenças cerebrovasculares (DCV) estão entre as principais causas de mortalidade no mundo e a temperatura do ar é um dos seus fatores de risco, embora sua relação seja pouco estudada no Brasil. Este artigo objetiva investigar a relação entre temperatura do ar e mortalidade por DCV em 10 microrregiões nas cinco grandes regiões brasileiras. Foi realizado estudo de séries temporais com os óbitos diários por DCV e a média diária de temperatura do ar no período de 1996 a 2017. Foram utilizando dados do Departamento de Informática do SUS (DATASUS) e modelos aditivos generalizados com distribuição de Poisson e os riscos relativos e atribuíveis foram estimados (com intervalo de confiança de 95%) até uma defasagem de 14 dias com modelos DLNM (distributed lag non-linear models). No período ocorreram 531.733 óbitos por DCV nestas microrregiões, dos quais 21.220 (11.138-30.546) atribuíveis à temperatura do ar. As temperaturas de mortalidade mínima variaram entre 20,1°C em Curitiba a 29,6°C em Belém. Foram observadas associações entre temperaturas não ótimas do ar e aumento no risco de óbito em todas as cinco regiões brasileiras, destacando Manaus com risco relativo (RR) 1,53 (1,22-1,91) e Campo Grande com RR 1,52 (1,18-1,94) no frio, e Manaus com RR 1,75 (1,35-2,26) e Brasília com RR 1,36 (1,15-1,60) no calor.


Assuntos
Poluição do Ar , Doenças Cardiovasculares , Transtornos Cerebrovasculares , Poluição do Ar/efeitos adversos , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Temperatura Baixa , Humanos , Mortalidade , Temperatura
3.
J Infect Dev Ctries ; 16(6): 981-992, 2022 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-35797292

RESUMO

The objectives of this study were to determine the prevalence of cerebrovascular diseases caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to assess the pharmacological agents used in such cases as reported in the literature. Patient files were retrospectively scanned to determine the prevalence of neurological symptoms of the central nervous system (headache, dizziness, lack of smell and taste, numbness in arms and legs, change in consciousness, muscle weakness, loss of urine and stool control) and cerebrovascular diseases (ischemic cerebrovascular diseases, cerebral venous sinus thrombosis, intracerebral hemorrhage, subarachnoid/subdural hemorrhage) in 2019 novel coronavirus (2019-nCoV) disease (COVID-19) cases (n = 20,099). The diagnostic laboratory, radiology examinations and treatments applied to these cases were recorded. The data from studies presenting cerebrovascular diseases associated with SARS-Cov-2, which constituted 0.035% of all cases, were systematically evaluated from electronic databases. During the treatment of cerebrovascular diseases, it was discovered that high doses of enoxaparin sodium anti-Xa are combined with apixaban or acetylsalicylic acid or clopidogrel or piracetam, and mannitol, in addition to SARS-CoV-2 treatment modalities. While neurological symptoms of the central nervous system are uncommon in cases of SARS-CoV-2 infection, cerebrovascular diseases are far less common, according to the findings of this study. Acute cerebral ischemia was discovered to be the most common cerebrovascular disease associated with SARS-CoV-2. The mortality rate increases with the association between SARS-CoV-2 and cerebrovascular disease.


Assuntos
COVID-19 , Transtornos Cerebrovasculares , Aspirina , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/mortalidade , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/mortalidade , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/mortalidade , Clopidogrel , Enoxaparina/análogos & derivados , Humanos , Manitol , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Piracetam , Pirazóis , Piridonas , Estudos Retrospectivos , SARS-CoV-2
4.
Wiad Lek ; 75(5 pt 1): 1152-1155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35758494

RESUMO

OBJECTIVE: The aim: To determine national trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes. PATIENTS AND METHODS: Materials and methods: Data from official sources of statistical information of Ukraine were used and systematic analysis and generalization of the obtained data was performed and trends in morbidity and mortality from diseases of the circulatory system, cerebrovascular diseases and strokes in Ukraine were calculated. RESULTS: Results: Were found tendencies to decrease of national levels of prevalence and primary morbidity in Ukraine for DCS (-16.3 % and -28.0 %), CVD (-22.8 % and 24.1 %) and strokes (-12.2 %) with significant trends (+83.9 %) of increase in primary incidence of strokes in 2010-2017 with fairly high and threatening levels for 2017 (respectively 22199563, 2521601 and 96978 - prevalence and 1725137, 290557 and 96978 - primary incidence). National levels of reduction of deaths from DCS in Ukraine from 440369 (2013) to 389348 (2019) with a trend of -11.6 % and a decrease in mortality due to CVD from 94267 (2013) to 76232 (2019) with a trend -19.1 % were found. CONCLUSION: Conclusions: The trends to reduce of national prevalence, primary morbidity and mortality rates in Ukraine for DCS, CVD and stroke are fully consistent with other global trends of reduction of these levels among world countries.


Assuntos
Sistema Cardiovascular , Transtornos Cerebrovasculares , Acidente Vascular Cerebral , Transtornos Cerebrovasculares/epidemiologia , Humanos , Morbidade , Mortalidade , Prevalência , Acidente Vascular Cerebral/epidemiologia
5.
Zhonghua Yu Fang Yi Xue Za Zhi ; 56(5): 567-573, 2022 May 06.
Artigo em Chinês | MEDLINE | ID: mdl-35644969

RESUMO

Objective: Predictive models were used to evaluate the impact of common risk factors on the number of cardio-cerebrovascular deaths and the probability of premature death. Methods: Using the data for China estimated by the Global Burden of Disease study 2015 (GBD 2015), we calculated the population attribution fraction (PAF) of risk factors. The proportional change model was used to estimate the number of unattributable deaths by 2030, and to predict the number of deaths, mortality, standardized mortality and probability of premature death by 2030. Results: According to the natural change trend of risk factors from 1990 to 2015, the number of deaths and mortality would reach 6.12 million and 428.53/100 000 by 2030, with an increase of 59.92% and 52.87%. By 2030, the probability of premature death from cardio-cerebrovascular diseases among Chinese aged 30-70 years old would continue to decline, from 11.43% to 11.28% for men, and from 5.79% to 4.43% for women. If the goals of all included risk factors were reached by 2030, 2 289 200 cardio-cerebrovascular deaths would be avoided. If only the exposure to a single risk factor was achieved by 2030, blood pressure, total cholesterol, and fine particulate matter exposure were the three most important factors affecting cardio-cerebrovascular deaths, which would reduce 1 332 800, 609 100 and 306 800 deaths, respectively. Among the involved risk factors, the control of blood pressure would mostly decrease the number of deaths due to ischemic heart disease and hemorrhagic stroke, about 677 300 and 391 100 deaths, accordingly. Conclusion: The control of risk factors is of great significance in reducing deaths and probability of premature death due to cardio-cerebrovascular diseases. If the control targets of all risk factors could be achieved by 2030, the burden of cardio-cerebrovascular diseases would be reduced greatly.


Assuntos
Transtornos Cerebrovasculares , Mortalidade Prematura , Adulto , Idoso , Pressão Sanguínea , Transtornos Cerebrovasculares/epidemiologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
6.
J Neural Transm (Vienna) ; 129(8): 961-976, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35705878

RESUMO

Depression is common in older individuals and is associated with high disability and increased mortality, yet the factors predicting late-life depression (LLD) are poorly understood. The relationship between of depressive disorder, age- and disease-related processes have generated pathogenic hypotheses and provided new treatment options. LLD syndrome is often related to a variety of vascular mechanisms, in particular hypertension, cerebral small vessel disease, white matter lesions, subcortical vascular impairment, and other processes (e.g., inflammation, neuroimmune regulatory dysmechanisms, neurodegenerative changes, amyloid accumulation) that may represent etiological factors by affecting frontolimbic and other neuronal networks predisposing to depression. The "vascular depression" hypothesis suggests that cerebrovascular disease (CVD) and vascular risk factors may predispose, induce or perpetuate geriatric depressive disorders. It is based on the presence of various cerebrovascular risk factors in many patients with LLD, its co-morbidity with cerebrovascular lesions, and the frequent development of depression after stroke. Other findings related to vascular depression are atrophy of the medial temporal cortex or generalized cortical atrophy that are usually associated with cognitive impairment. Other pathogenetic hypotheses of LLD, such as metabolic or inflammatory ones, are briefly discussed. Treatment planning should consider there may be a modest response to antidepressants, but several evidence-based and novel treatment options for LLD exist, such as electroconvulsive therapy, transcranial magnetic stimulation, neurobiology-based psychotherapy, as well as antihypertension and antiinflammatory drugs. However, their effectiveness needs further investigation, and new methodologies for prevention and treatment of depression in older individuals should be developed.


Assuntos
Transtornos Cerebrovasculares , Transtorno Depressivo , Idoso , Antidepressivos/uso terapêutico , Atrofia/patologia , Encéfalo/patologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Depressão/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Humanos
7.
JAMA Netw Open ; 5(6): e2217375, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35699955

RESUMO

Importance: Vaccinations are paramount to halt the COVID-19 pandemic, and safety data are essential to determine the risk-benefit ratio of each COVID-19 vaccine. Objective: To evaluate the association between the AZD1222, BNT162b2, and mRNA-1273 vaccines and subsequent thromboembolic and thrombocytopenic events. Design, Setting, and Participants: This self-controlled case series used individual-level data from national registries in Norway, Finland, and Denmark. Participants included individuals with hospital contacts because of coronary artery disease, coagulation disorders, or cerebrovascular disease between January 1, 2020, and May 16, 2021. Exposures: AZD1222, BNT162b2, or mRNA-1273 vaccine. Main Outcomes and Measure: Relative rate (RR) of hospital contacts for coronary artery disease, coagulation disorders, or cerebrovascular disease in a 28-day period following vaccination compared with the control period prior to vaccination. Results: We found 265 339 hospital contacts, of whom 112 984 [43%] were for female patients, 246 092 [93%] were for patients born in 1971 or earlier, 116 931 [44%] were for coronary artery disease, 55 445 [21%] were for coagulation disorders, and 92 963 [35%] were for cerebrovascular disease. In the 28-day period following vaccination, there was an increased rate of coronary artery disease following mRNA-1273 vaccination (RR, 1.13 [95% CI, 1.02-1.25]), but not following AZD1222 vaccination (RR, 0.92 [95% CI, 0.82-1.03]) or BNT162b2 vaccination (RR, 0.96 [95% CI, 0.92-0.99]). There was an observed increased rate of coagulation disorders following all 3 vaccines (AZD1222: RR, 2.01 [95% CI, 1.75-2.31]; BNT162b2: RR, 1.12 [95% CI, 1.07-1.19]; and mRNA-1273: RR, 1.26 [95% CI, 1.07-1.47]). There was also an observed increased rate of cerebrovascular disease following all 3 vaccines (AZD1222: RR, 1.32 [95% CI, 1.16-1.52]; BNT162b2: RR, 1.09 [95% CI, 1.05-1.13]; and mRNA-1273: RR, 1.21 [95% CI, 1.09-1.35]). For individual diseases within the main outcomes, 2 notably high rates were observed: 12.04 (95% CI, 5.37-26.99) for cerebral venous thrombosis and 4.29 (95% CI, 2.96-6.20) for thrombocytopenia, corresponding to 1.6 (95% CI, 0.6-2.6) and 4.9 (95% CI, 2.9-6.9) excess events per 100 000 doses, respectively, following AZD1222 vaccination. Conclusions and Relevance: In this self-controlled case series, there was an increased rate of hospital contacts because of coagulation disorders and cerebrovascular disease, especially for thrombocytopenia and cerebral venous thrombosis, following vaccination with AZD1222. Although increased rates of several thromboembolic and thrombocytopenic outcomes following BNT162b2 and mRNA-1273 vaccination were observed, these increases were less than the rates observed after AZD1222, and sensitivity analyses were not consistent. Confirmatory analysis on the 2 mRNA vaccines by other methods are warranted.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Transtornos Cerebrovasculares , Doença da Artéria Coronariana , Trombocitopenia , Trombose Venosa , Vacina de mRNA-1273 contra 2019-nCoV , Vacina BNT162 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Transtornos Cerebrovasculares/induzido quimicamente , Transtornos Cerebrovasculares/epidemiologia , ChAdOx1 nCoV-19 , Doença da Artéria Coronariana/induzido quimicamente , Doença da Artéria Coronariana/epidemiologia , Dinamarca , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Pandemias , Sistema de Registros , Trombocitopenia/induzido quimicamente , Trombocitopenia/epidemiologia , Trombose Venosa/induzido quimicamente , Trombose Venosa/epidemiologia
8.
Am J Emerg Med ; 58: 100-105, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35660366

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic situation is a state that has had a great impact on the medical system and society. To respond to the pandemic situation, various methods, such as a pre-triage system, are being implemented in the emergency medical field. However, there are insufficient studies on the effects of this pandemic situation on patients visiting the emergency department (ED), especially those with cardio/cerebrovascular diseases (CVD)1 classified as time-dependent emergencies. METHODS: We performed a retrospective analysis of a cohort of patients from April 2020 to December 2020 (April 2020 was when the pre-triage system was established) compared to a parallel comparison patient cohort from 2019. The primary outcome was in-hospital mortality. CVD was defined by the patient's final diagnosis. RESULTS: During the same period, the number of patients who had visited the ED after COVID-19 had decreased to 79.1% of the number of patients who had visited the ED before COVID-19. The overall patient mortality and the mortality in the patients cardiovascular disease had both increased, while the mortality from cerebrovascular disease did not increase. Meanwhile, the ED length of stay had increased in all patients but did not increase in the patients with cardiovascular disease. CONCLUSION: As with prior studies conducted in other regions, in our study, the total number of ED visits were decreased compared to before COVID-19. The overall mortality had increased, particularly in the patients with cardiovascular disease.


Assuntos
COVID-19 , Doenças Cardiovasculares , Transtornos Cerebrovasculares , COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Serviço Hospitalar de Emergência , Humanos , Pandemias , Estudos Retrospectivos , SARS-CoV-2
9.
Sci Rep ; 12(1): 8119, 2022 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-35581260

RESUMO

Limited information is available on the epidemiological characteristics of major causes of death in the last 18 years. In this study, we investigated the epidemiological characteristics of the top 5 causes of death in China from 2000 to 2017. Data were obtained from the 18-year reports of Ministry of Health and analyzed by Grid Search Method, Permutation test, and log-linear regression model. The top 5 consistent causes of death, malignant tumor, cerebrovascular disease, heart trouble, respiratory disease, trauma and toxicosis accounted for 82.6% in 2000, 86.49% in 2017 in urban areas and 83.31% in 2000, 88.34% in 2017 in rural areas. The increasing trends (P < 0.05) of proportions of death of malignant tumor, cerebrovascular disease, and heart trouble have average annual percent change (AAPC) = 0.5%, 0.3%, 2.4% in urban areas and 1.7%, 1.5%, 4.3% in rural areas. The AAPCs of respiratory disease are - 1.4% in urban areas and - 3.6% in rural areas. Cardio-cerebrovascular disease increased (Urban: 39.02% to 43.56%, AAPC = 1.3%, P < 0.05; Rural: 32.03% to 45.91%, AAPC = 2.7%, P < 0.05) steeply from 2000 to 2017 which are higher than that of malignant tumor (P < 0.05). The top 5 causes of death in China accounted for more than 85% of all deaths in 2017, in which cardio-cerebrovascular disease accounted for the largest proportion with the steepest increasing trend.


Assuntos
Transtornos Cerebrovasculares , Cardiopatias , Neoplasias , Doenças Respiratórias , Causas de Morte , Transtornos Cerebrovasculares/epidemiologia , China/epidemiologia , Humanos , Neoplasias/epidemiologia , Doenças Respiratórias/epidemiologia , População Rural , População Urbana
10.
BMC Pregnancy Childbirth ; 22(1): 433, 2022 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-35610618

RESUMO

BACKGROUND: Physiologic changes during pregnancy affect the development of postpartum cerebrovascular disease (CVD) in women with Moyamoya disease. Due to the rare prevalence of Moyamoya disease and its large regional variations, large-scale based studies on the risk of CVD after delivery have not been conducted. This study aimed to evaluate whether women with Moyamoya disease have an increased risk of CVD after delivery. METHODS: Research data was collected from the National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Patients who delivered in Korea from 2007 to 2014 were enrolled in this study. We classified women as having CVD if they were diagnosed with any of the following conditions between delivery and December 31, 2016; cerebral infarction (I63.X in the International Classification of Diseases-10th Revision [ICD-10]) and/or intracranial hemorrhage (I61.X, I62.X in ICD-10) and/or subarachnoid hemorrhage (I60.X in ICD-10). Women with Moyamoya disease were identified as having I67.5 in ICD-10. We matched the study cohort by the ratio of 1:10 to analyze the risk CVD occurrence. The matching technique applied in this study was based on the variables of age and parity. To evaluate the adjusted hazard ratio (HR) for CVD in women with Moyamoya disease, we used multivariate Cox proportional hazard regression. RESULTS: Among a total of 3,611,216 Korean women who underwent delivered, we identified 412 women with Moyamoya disease diagnosis and 1420 age- and parity-matched women without Moyamoya disease (control). Compared to the control group, women with Moyamoya disease had a significantly higher rate of Cesarean section, overt DM, and essential hypertension (all p < 0.0001). Among women with Moyamoya disease, 55 (13.35%) women developed CVD within the follow-up postpartum period. The presence of Moyamoya disease was associated with an increased risk of CVD after delivery (adjusted HR 37.42; 95% confidence interval (CI) 17.50-80.02 within 2.3 years) after adjusting for pregnancy-induced hypertension, gestational diabetes mellitus, pregestational diabetes, chronic hypertension. CONCLUSION: This population based study showed that the occurrence rate of CVD after delivery was higher in women with Moyamoya disease than in those without. Therefore, careful and long-term postpartum surveillance is required for women with Moyamoya disease.


Assuntos
Transtornos Cerebrovasculares , Doença de Moyamoya , Transtornos Cerebrovasculares/epidemiologia , Cesárea , Feminino , Humanos , Masculino , Doença de Moyamoya/complicações , Doença de Moyamoya/epidemiologia , Gravidez , Gestantes , República da Coreia/epidemiologia , Fatores de Risco
11.
Environ Sci Pollut Res Int ; 29(30): 45031-45043, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35460001

RESUMO

Although it is biologically plausible, findings relating radon exposure to the risk of cerebrovascular disease (CeVD) are inconsistent and inconclusive. To investigate whether radon exposure was associated with the risk of CeVD, we qualitatively and quantitatively summarized the literature on radon and CeVD in both occupational and general populations. A search of PubMed, Embase, Scopus, and Web of Science was performed for peer-reviewed articles published through March 2022. Studies were excluded if radon exposure was not assessed separately from other ionizing radiation. In the meta-analysis, excess relative risks (ERRs) were converted to relative risks (RRs), and the pooled RRs and 95% confidence intervals (CIs) were determined using the random-effects model (DerSimonian and Laird). In the systematic review, nine eligible studies were summarized. Six occupational studies indicated inconsistent associations between cumulative radon exposure and CeVD mortality among mine workers. With available data from four updated occupational studies (99,730 mine workers and 2745 deaths), the pooled RR of radon exposure with CeVD mortality showed a non-significant association (1.10, 95% CI 0.92, 1.31). Three studies (841,270 individuals and 24,288 events) conducted in general populations consistently demonstrated a significant inverse relationship between residential radon exposure and risk of CeVD. The existing literature suggested a potential link between radon exposure and CeVD risk in general population. The inconsistent association in occupationally exposed populations may be explained by different methods of radon assessment and other methodological issues. Since radon exposure is a common public health issue, more rigorously designed epidemiologic studies, especially in the general population are warranted.


Assuntos
Transtornos Cerebrovasculares , Neoplasias Pulmonares , Doenças Profissionais , Exposição Ocupacional , Radônio , Transtornos Cerebrovasculares/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Projetos de Pesquisa , Risco
12.
BMC Cardiovasc Disord ; 22(1): 161, 2022 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-35397488

RESUMO

PURPOSE: We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting. MATERIALS AND METHODS: We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis. RESULTS: Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35-0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12-0.80)], without history of smoking [OR 0.34 (0.15-0.80)], and without hypertension [OR = 0.42 (95% CI 0.19-0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68-0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32-0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04-0.73)] without a history of hypertension [OR = 0.34 (0.13-0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14-0.86)]. CONCLUSION: Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.


Assuntos
Transtornos Cerebrovasculares , Hipertensão , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Determinação da Pressão Arterial , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
13.
Neurology ; 98(24): e2454-e2464, 2022 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-35444054

RESUMO

BACKGROUND AND OBJECTIVES: Cerebrovascular disease (CBVD) is frequently comorbid with autopsy-confirmed Alzheimer disease (AD), but its contribution to the clinical presentation of AD remains unclear. We leveraged the National Alzheimer's Coordinating Center (NACC) uniform and neuropathology datasets to compare the cognitive and functional trajectories of AD+/CBVD+ and AD+/CBVD- brain donors. METHODS: The sample included NACC brain donors with autopsy-confirmed AD (Braak stage ≥3, Consortium to Establish a Registry for Alzheimer's Disease score ≥2) and complete Uniform Data Set (UDS) evaluations between 2005 and 2019, with the most recent UDS evaluation within 2 years of autopsy. CBVD was defined as moderate to severe arteriosclerosis or atherosclerosis. We used propensity score weighting to isolate the effects of comorbid AD and CBVD. This method improved the balance of covariates between the AD+/CBVD+ and AD+/CBVD- groups. Longitudinal mixed-effects models were assessed with robust bayesian estimation. UDS neuropsychological test and the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) scores were primary outcomes. RESULTS: Of 2,423 brain donors, 1,476 were classified as AD+/CBVD+. Compared with AD+/CVBD- donors, the AD+/CBVD+ group had accelerated decline (i.e., group × time effects) on measures of processing speed (ß = -0.93, 95% CI -1.35, -0.51, Bayes factor [BF] 130.75), working memory (ß = 0.05, 95% CI 0.02, 0.07, BF 3.59), verbal fluency (ß = 0.10, 95% CI 0.04, 0.15, BF 1.28), naming (ß = 0.09, 95% CI 0.03, 0.16, BF = 0.69), and CDR-SB (ß = -0.08, 95% CI -0.12, -0.05, BF 18.11). Effects ranged from weak (BFs <3.0) to strong (BFs <150). We also found worse performance in the AD+/CBVD+ group across time on naming (ß = -1.04, 95% CI -1.83, -0.25, BF 2.52) and verbal fluency (ß = -0.73, 95% CI -1.30, -0.15, BF 1.34) and more impaired CDR-SB scores (ß = 0.45, 95% CI 0.01, 0.89, BF 0.33). DISCUSSION: In brain donors with autopsy-confirmed AD, comorbid CBVD was associated with an accelerated functional and cognitive decline, particularly on neuropsychological tests of attention, psychomotor speed, and working memory. CBVD magnified effects of AD neuropathology on semantic-related neuropsychological tasks. Findings support a prominent additive and more subtle synergistic effect for comorbid CBVD neuropathology in AD.


Assuntos
Doença de Alzheimer , Transtornos Cerebrovasculares , Disfunção Cognitiva , Doença de Alzheimer/patologia , Autopsia , Teorema de Bayes , Encéfalo/patologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/patologia , Disfunção Cognitiva/patologia , Humanos , Testes Neuropsicológicos
14.
Stroke ; 53(6): 1954-1963, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35300530

RESUMO

BACKGROUND: Low birth weight is associated with an increased risk of adulthood cerebrovascular disease (CVD). Not much is known about effects of early childhood growth. We studied whether the risk of adult CVD is associated with growth or nutritional factors during early childhood. METHODS: Within the Northern Finland Birth Cohort 1966, 11 991 persons were followed from birth to 52 years of age. CVD diagnoses were extracted from national hospital and death registers with diagnostic coding based on the World Health Organization recommendations. Cox proportional hazard models were used to estimate associations of childhood growth variables, growth trajectories (by Latent Class Growth Modeling), and nutritional factors with adult CVD, for example, ischemic and hemorrhagic strokes. The analyses were adjusted for childhood socioeconomic status and birth weight. RESULTS: A total of 453 (3.8%) CVDs were recorded during follow-up. Among females, groups with low early childhood weight and height had an increased risk for adulthood ischemic CVDs, with an adjusted hazard ratio of 1.97 (95% CI, 1.21-3.20) and 2.05 (CI, 1.11-3.81), respectively. In addition, females with body mass index over 1 SD at body mass index rebound had an increased risk for ischemic CVDs (adjusted hazard ratio, 1.90 [CI, 1.19-3.04]) compared with females with body mass index -1 to +1 SD. These associations were not found among males. CONCLUSIONS: The findings suggest that timing of weight gain during childhood is of significance for development of CVD risk among females.


Assuntos
Doenças Cardiovasculares , Transtornos Cerebrovasculares , Adulto , Peso ao Nascer , Estatura , Índice de Massa Corporal , Transtornos Cerebrovasculares/epidemiologia , Pré-Escolar , Feminino , Humanos , Masculino , Fatores de Risco
16.
Rocz Panstw Zakl Hig ; 73(1): 87-97, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35322961

RESUMO

Background: Many scientific reports have shown a decrease in total cerebrovascular disease (CeVD) mortality over the past few decades, but too little attention has been paid to premature mortality. CeVD accounted for 22.5% and 17.8% of premature cardiovascular disease deaths in Poland, in 2000 and 2016, respectively. Objective: The aim of the study was to analyse premature CeVD mortality in the Polish population in the recent years, the dynamics of its changes and the potential factors that may have contributed to the decline in mortality. The main goal of the study was to overview the levels and trends in premature CeVD mortality with an emphasis on haemorrhagic, ischaemic and unspecified (not specified as haemorrhagic or ischaemic) stroke. Material and methods: The analysis was based on a database of the Central Statistical Office of Poland and included data from 2000-2016 on premature cerebrovascular deaths occurring between 25 and 64 years of age (N=104,786). CeVD and haemorrhagic, ischaemic or unspecified stroke were coded with ICD-10 codes I60-I69, I61-I62, I63 and I64, respectively. The analysis included assessment of CeVD deaths distribution and evaluation of age-specific mortality rates in 10-year age groups and age-standardised mortality rates (SMR) in the age group 25-64 years, separately for men and women. Trends in SMRs have been studied in the period 2000-2016. Results: The number of CeVD deaths decreased by 32.8% in men and 48.8% in women. There was a two-fold decline in CeVD mortality: from 59 to 29 male and from 30 to 12 female per 100,000. In addition, a 2-year increase in the median age of CeVD death was observed (Men: 56.4 to 58.4 years, Women: 56.4 to 58.7 years, p<0.001). A statistically significant decline in mortality (per 100,000) was also noticed for haemorrhagic stroke (Men: 18.7 to 10.4; Women: 9.6 to 3.8), ischaemic stroke (Men: 11.8 to 8.4; Women: 4.7 to 3.0) and unspecified stroke (Men: 19.7 to 3.5; Women: 9.1 to 1.3). Conclusions: A substantial decline in premature CeVD mortality was observed in the period 2000-2016. Additionally, the number of deaths that could not be classified as haemorrhagic or ischaemic stroke death decreased significantly. The increasingly widespread use of new post-stroke therapies and their availability make it possible to expect a further decrease in CeVD mortality. However, the necessary actions should be taken to compensate for the disparities in CeVD mortality between men and women.


Assuntos
Isquemia Encefálica , Transtornos Cerebrovasculares , Acidente Vascular Cerebral , Adulto , Transtornos Cerebrovasculares/epidemiologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade Prematura , Polônia/epidemiologia , Acidente Vascular Cerebral/epidemiologia
17.
BMJ Open ; 12(3): e053059, 2022 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-35236730

RESUMO

OBJECTIVES: The long-term acute stroke outcome has not been well studied in the Middle-Eastern population. The primary objective of our study is to compare the long-term outcome of acute ischaemic stroke (IS) with/without previous cerebrovascular/cardiovascular disease (CVD) to stroke mimics (SM) with CVD. SETTINGS AND PARTICIPANTS: The Qatar stroke database was reviewed for IS and SM admissions in Qatari Nationals between 2013 and 2019. OUTCOMES: Patients were prospectively assessed for development of recurrent stroke, myocardial infarction or death. Frequency of major cardiovascular events (MACEs) were compared between patients with or without a previous CVD. RESULTS: There were 1114 stroke admissions (633 IS (prior CVD 211/18.9%), 481 SM (prior CVD 159/14.3%)). Patients with IS/CVD were significantly older versus others (IS/CVD: 68.3±12.2; IS/no CVD: 63.3±14.4; SM/CVD: 67.6±13.1; SM/no CVD: 52.4±17.9. p<0.0001). Vascular risk factors were significantly higher in patients with IS and SM with previous CVD. Functional recovery (90-day mRS 0-2) was significantly better in SM/no CVD (IS/CVD: 55.0%; IS/no CVD: 64.2%; SM/CVD 59.7%; SM/no CVD: 88.8%. p<0.001). MACE occurred in 36% (76/211) IS/CVD, 24.9% (105/422) IS/no CVD, 22.0% (35/179) SM/CVD and only 6.8% (22/322) SM/no CVD. MACE occurred mostly during the first year of follow-up. Mortality 90 days was significantly higher in IS/CVD (IS/CVD 36%; IS/no CVD 24.9%; SM/CVD: 22%; SM/no CVD: 6.8%. p<0.0001). CONCLUSIONS: Prior CVD significantly increases the risk of MACE and early mortality in IS or SM patients. Age, male gender, obesity, atrial fibrillation and admission National Institute of Health Stroke Scale also increases risk of MACE during follow-up. Hence, aggressive vascular risk factor modification is needed even in patients with SM.


Assuntos
Isquemia Encefálica , Transtornos Cerebrovasculares , AVC Isquêmico , Infarto do Miocárdio , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
18.
Cardiovasc Diabetol ; 21(1): 26, 2022 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-35172838

RESUMO

BACKGROUND: Iron stores, estimated as ferritin levels, and type 2 diabetes (T2D) have been associated previously, while findings regarding coronary heart disease (CHD) and cerebrovascular disease (CEVD) are still inconclusive. No study has focused on simultaneous evaluation of associations between iron stores and the above cardiometabolic diseases (CMD) in the same population. We aim to evaluate the association between serum ferritin and risk of T2D, CHD and CEVD in Scottish population over a wide range of ferritin levels. METHODS: Longitudinal study in 6,497 participants of the 1995 and 1998 Scottish health surveys, who were followed-up until 2011. Cox regression models were conducted adjusting for age, sex/menopausal status, fibrinogen, GGT levels, smoking, alcohol consumption, total cholesterol, HDL-cholesterol, blood pressure, and BMI. Ferritin was used as continuous (sex/menopausal status-specific Z score) and categorical variable (sex/menopausal status-specific quartiles, quintiles and sextiles). RESULTS: During follow-up, 4.9% of the participants developed T2D, 5.3% CHD, and 2.3% CEVD. By using ferritin quartiles, serum ferritin was positively associated with T2D, CHD and CEVD but only the association with T2D remained after adjustment for covariates [Quartile 4 v. 1: adjusted HR 95% CI 1.59 (1.10-2.34); P = 0.006]. When ferritin sextiles were used (6 v. 1), the ferritin-CEVD association became slightly stronger and significant [adjusted HR 95% CI 2.08 (1.09-3.94); P = 0.024]. CONCLUSIONS: Iron stores relate differently to each CMD. Serum ferritin levels were positively and independently associated with incident T2D, and with incident CEVD if higher cut-off points for high ferritin levels were considered.


Assuntos
Transtornos Cerebrovasculares , Doença das Coronárias , Ferritinas/sangue , Adulto , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Humanos , Estudos Longitudinais , Fatores de Risco , Escócia/epidemiologia
19.
Epilepsy Behav ; 128: 108582, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35123242

RESUMO

PURPOSE: To characterize the relationship between functional seizures (FSe), cerebrovascular disease (CVD), and functional stroke. METHOD: A retrospective case-control study of 189 patients at a single large tertiary medical center. We performed a manual chart review of medical records of patients with FSe or epileptic seizures (ES), who also had ICD code evidence of CVD. The clinical characteristics of FSe, ES, CVD, and functional stroke were recorded. Logistic regression and Welch's t-tests were used to evaluate the differences between the FSe and ES groups. RESULTS: Cerebrovascular disease was confirmed in 58.7% and 87.6% of patients with FSe or ES through manual chart review. Stroke was significantly more common in patients with ES (76.29%) than FSe (43.48%) (p = 4.07 × 10-6). However, compared to nonepileptic controls FSe was associated with both CVD (p < 0.0019) and stroke (p < 6.62 × 10-10). Functional stroke was significantly more common in patients with FSe (39.13%) than patients with ES (4.12%) (p = 4.47 × 10-9). Compared to patients with ES, patients with FSe were younger (p = 0.00022), more likely to be female (p = 0.00040), and more likely to have comorbid mental health needs including anxiety (p = 1.06 × 10-6), PTSD or history of trauma (e.g., sexual abuse) (p = 1.06 × 10-13), and bipolar disorder (p = 0.0011). CONCLUSION: Our results confirm the initial observation of increased CVD in patients with FSe and further suggest that patients with FSe may be predisposed to developing another functional neurological disorder (FND) (i.e., functional stroke). We speculate that this may be due to shared risk factors and pathophysiological processes that are common to various manifestations of FND.


Assuntos
Transtornos Cerebrovasculares , Acidente Vascular Cerebral , Estudos de Casos e Controles , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Convulsões/complicações , Convulsões/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
20.
Radiat Environ Biophys ; 61(1): 5-16, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35182179

RESUMO

Incidence risks for cerebrovascular diseases (CeVD) and some types of stroke in a cohort of 22,377 Russian Mayak nuclear workers chronically exposed to ionising radiation and followed up until the end of 2018 are reported. Among total 9469 cases of CeVD, 2078 cases were strokes that included 262 hemorrhagic strokes (HS) and 1611 ischemic strokes (IS). Data evaluation was performed with categorical and dose-response analyses estimating the relative risk (RR) and excess relative risk (ERR) per unit cumulative liver absorbed dose of external gamma-ray or internal alpha-particle exposure based on a linear model utilizing the AMFIT module of the EPICURE software. CeVD incidence was found to be significantly associated with cumulative radiation dose: ERR/Gy was 0.37 (95% confidence interval (CI) 0.27, 0.47) in males and 0.47 (95% CI 0.31, 0.66) in females for external exposure, and 0.31 (95% CI 0.11, 0.59) in males and 0.32 (95% CI 0.11, 0.61) in females for internal exposure. When the model for the analysis of external radiation effect did not include an adjustment for alpha radiation dose (and vice versa), the radiogenic risk estimate increased notably both for males and for females. In contrast, exclusion from or inclusion in the model of additional adjustments for non-radiation factors did not notably change the risk estimates. ERR/Gy of external gamma dose for CeVD incidence significantly decreased with increasing attained age (males and females) and duration of employment (females). No significant associations of either stroke or its types with cumulative gamma-ray dose of external exposure or alpha-particle dose of internal exposure were found.


Assuntos
Transtornos Cerebrovasculares , Doenças Profissionais , Exposição Ocupacional , Acidente Vascular Cerebral , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Feminino , Humanos , Incidência , Masculino , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Federação Russa/epidemiologia , Acidente Vascular Cerebral/epidemiologia
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