Background and Purpose-Increasing evidence links infections to atherosclerosis. Case-control and cohort studies have found that infections, especially respiratory and dental, are associated with coronary heart disease. However, data on the association of infections with cerebrovascular disease are limited, especially beyond Europe and the United States. We assessed the relationship between recent infections and atherothrombotic disease in a South American cohort. Methods-We conducted a case-control study of 105 cases and 354 control subjects in a Buenos Aires healthcare system matched by age (mean age, 73.2Ϯ12.3 and 72.9Ϯ12.8 years), sex, and major cardiovascular risk factors. Cases were patients hospitalized with atherothrombotic ischemic stroke from December 2006 to October 2007. Control subjects were randomly assigned from an electronic outpatient database. Data from the preceding year on inpatient and ambulatory respiratory, urinary and abdominal infections as well as peripheral white blood cell count were collected. Results-Infections were more frequent in cases than control subjects (29% versus 13%; OR, 2.6; 95% CI, 1.4 to 4.5;Pϭ0.0004); however, this was driven by community-acquired respiratory tract infections (19% versus 6%; OR, 3.9; 95% CI, 1.9 to 8; PϽ0.001) because there were no differences between cases and control subjects for other types of infection. Respiratory tract infections were the most prevalent type of infection during the 3 months before an atherothrombotic ischemic event, occurring more in cases compared with control subjects (17% versus 4%; OR, 5; 95% CI, 2.2 to 11.3; PϽ0.001). In multivariable analysis adjusting for major vascular risk factors, history of respiratory infection in the prior year was associated more with cases than control subjects (OR, 4.9; 95% CI, 2.3 to 10.2;PϽ0.001). White blood cell count was slightly higher in cases versus control subjects (7602Ϯ2058 versus 7121.6Ϯ1947, Pϭ0.01). Conclusion-In this South American cohort, recent respiratory tract infections were significantly associated with atherothrombotic stroke, suggesting that prompt identification and treatment of individuals with or at risk for these infections may mitigate the burden from this type of stroke.

As population grows old, the number of persons at risk of cardiovascular events also grows. Though octogenarians form a small percentage of the general population their absolute risk of coronary and cerebrovascular disease is high, but there is still some doubt as to whether high plasma cholesterol levels increase vascular risk in this age group, as published data are conflicting. There is evidence that elevated plasma cholesterol increases the risk of coronary artery disease in older adults, and an inverse linear relationship was found between HDL cholesterol levels and the risk of mortality from ischemic heart disease in all age groups. The relationship between total plasma cholesterol and the risk of death from ischemic stroke is weak in younger populations and is even lower in people between 70 and 89 years, and is inverse for hemorrhagic stroke. However, studies showed that statin treatment lowers the risk of ischemic stroke, independently of age. Statins are underused in the elderly, perhaps because of lack of perception of the real vascular risk of older adults, concerns about statin efficacy or safety in this population, or the increase of comorbidities and polypharmacy which could affect adherence to drug-treatment. Trials designed to address this issues are urgently needed, in order to be able to make evidence-guided decisions on lipid management of the elderly.

Objective: Exposure to high altitude reduces oxygen supply to the central nervous system and may cause neuropsychological impairment. Aim of our study was to evaluate changes in neuropsychological performances of normal subjects when exposed to high and very high altitude, i.e. to conditions representing an experimental model for investigating cognitive functional changes occurring in clinical conditions characterized by reduced brain oxygen supply, such as obstructive sleep apnea or hypertension-related cerebrovascular damage.Design and Method: Forty-five normal subjects participating in the Himalaya's HIGHCARE expedition underwent an extensive neuropsychological and psychodiagnostic assessment at sea level (SL), at 3500 m and at 5400 m altitudes. Different cognitive domains were investigated with paper and pencil tools as well as with computerized tests (X50 eye-tracking device). Psychological status was assessed by clinical checklists.Results: While classic paper and pencil tests did not detect major changes with altitude, better cognitive performances scores were obtained in normoxia and at 3500 m than at 5400 m for computerized psychomotor (keyboard reaction times, KRT) and eye reaction times (ERT): KRT SL vs 5400 m 0.59 AE 0.15 sec vs 0.67 AE 0.17 sec (p < 0.04); KRT SL vs 3500 m 0.59 AE 0.15 sec vs 0.62 AE 0.17 sec (n.s.); KRT 3500 m vs 5400 m 0.62 AE 0.17 sec vs 0.67 AE 0.17 sec (n.s.). ERT SL vs 5400 m 0.44 AE 0.06 sec vs 0.46 AE 0.04 sec (p < 0.001); ERT SL vs 3500m 0.44 AE 0.06 sec vs 0.42 AE 0.05 sec (p < 0.007); ERT 3500m vs 5400m 0.42 AE 0.05 sec vs 0.46 AE 0.04 sec (p < 0.02).ERT were positively related to respiratory rate (RR) (r = 0.53, P < 0.0007). Gender differences were detected, with women having a better performance than men on psychomotor efficiency (% KRT responses) at 5400 m (p < 0.001).Conclusions: High altitude exposure induces specific alterations in cognitive functions, with significant impairment in cognitive performances at 5400m. Our data suggest that computerized tests used for the assessment could be more sensitive than paper and pencil ones, being able to detect even minimal hypoxia-induced changes in cognitive functions. Thus they might be useful in highlighting mild cognitive changes also in hypertensive patients with increased cerebrovascular risk.Objective: Left ventricular hypertrophy (LVH) has been increasingly recognized as a risk factor for stroke. Characterization of blood pressure (BP) using the 24-hour ambulatory blood pressure monitoring (ABPM) is superior to casual measurement in predicting cardiovascular target organ damage in patients with arterial hypertension. We aimed to determine the relationship between LVH and ABPM in patients after acute ischemic stroke.Design and method: We studied 80 subjects with acute ischemic stroke who underwent 24-h ABPM and cross-sectional and M-mode echocardiography. After six month a new ABPM was undergone. Patients were divided into two groups by presence and absence of LVH. Results:We included 40 patients with LVH and 40 patient...

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Objective: Exposure to high altitude reduces oxygen supply to the central nervous system and may cause neuropsychological impairment. Aim of our study was to evaluate changes in neuropsychological performances of normal subjects when exposed to high and very high altitude, i.e. to conditions representing an experimental model for investigating cognitive functional changes occurring in clinical conditions characterized by reduced brain oxygen supply, such as obstructive sleep apnea or hypertension-related cerebrovascular damage.Design and Method: Forty-five normal subjects participating in the Himalaya's HIGHCARE expedition underwent an extensive neuropsychological and psychodiagnostic assessment at sea level (SL), at 3500 m and at 5400 m altitudes. Different cognitive domains were investigated with paper and pencil tools as well as with computerized tests (X50 eye-tracking device). Psychological status was assessed by clinical checklists.Results: While classic paper and pencil tests did not detect major changes with altitude, better cognitive performances scores were obtained in normoxia and at 3500 m than at 5400 m for computerized psychomotor (keyboard reaction times, KRT) and eye reaction times (ERT): KRT SL vs 5400 m 0.59 AE 0.15 sec vs 0.67 AE 0.17 sec (p < 0.04); KRT SL vs 3500 m 0.59 AE 0.15 sec vs 0.62 AE 0.17 sec (n.s.); KRT 3500 m vs 5400 m 0.62 AE 0.17 sec vs 0.67 AE 0.17 sec (n.s.). ERT SL vs 5400 m 0.44 AE 0.06 sec vs 0.46 AE 0.04 sec (p < 0.001); ERT SL vs 3500m 0.44 AE 0.06 sec vs 0.42 AE 0.05 sec (p < 0.007); ERT 3500m vs 5400m 0.42 AE 0.05 sec vs 0.46 AE 0.04 sec (p < 0.02).ERT were positively related to respiratory rate (RR) (r = 0.53, P < 0.0007). Gender differences were detected, with women having a better performance than men on psychomotor efficiency (% KRT responses) at 5400 m (p < 0.001).Conclusions: High altitude exposure induces specific alterations in cognitive functions, with significant impairment in cognitive performances at 5400m. Our data suggest that computerized tests used for the assessment could be more sensitive than paper and pencil ones, being able to detect even minimal hypoxia-induced changes in cognitive functions. Thus they might be useful in highlighting mild cognitive changes also in hypertensive patients with increased cerebrovascular risk.Objective: Left ventricular hypertrophy (LVH) has been increasingly recognized as a risk factor for stroke. Characterization of blood pressure (BP) using the 24-hour ambulatory blood pressure monitoring (ABPM) is superior to casual measurement in predicting cardiovascular target organ damage in patients with arterial hypertension. We aimed to determine the relationship between LVH and ABPM in patients after acute ischemic stroke.Design and method: We studied 80 subjects with acute ischemic stroke who underwent 24-h ABPM and cross-sectional and M-mode echocardiography. After six month a new ABPM was undergone. Patients were divided into two groups by presence and absence of LVH. Results:We included 40 patients with LVH and 40 patient...