INTRODUCTION:
Vitamin D deficiency might be involved in the development of several diseases including hypertension, diabetes mellitus and cardiovascular disease. An inverse association between 25(OH) D levels and stroke was also emphasized in recent studies.
Objective:
To determine the rate of vitamin D deficiency among stroke survivors and risk of associated osteoporosis in a nationally representative population.
Methods:
Participants from the National Health and Nutritional Examination Survey (NHANES) from 2001 through 2006 were included. Serum 25(OH) D levels were measured using the DiaSorin RIA kit (Stillwater MN) and history of previous stroke and osteoporosis was ascertained by standard interview. Stroke survivors were then divided into 2 groups depending on serum 25(OH) D levels: <30ng/dL as vitamin D deficiency and ≥30ng/dL as normal. Comparisons of demographics and risk factors between two groups were performed using the SAS software. Multivariate analysis was performed to determine the association between vitamin D deficiency and osteoporosis in stroke survivors after adjusting for potential confounding factors.
Results:
There were 415 (4.0%) stroke survivors among the total 10,255 participants in NHANES. The mean age [±SD] of stroke survivors was 67.56 [±17.3] years and 211 (50.8%) were men. Mean 25(OH) D concentrations were found to be not significantly different in patients with stroke (20.35 versus 21.82ng/mL, p=0.657) although the rate of osteoporosis was significantly higher among stroke survivors (17.92% versus 6.99%, p<0.0001). Out of 415 stroke patients, vitamin D deficiency was seen in 71.0% of the patients (mean concentration of 17.3±6.4ng/dL) and was normal in 29.0% patients (mean concentration of 34.6±5.3ng/dL). The rates of osteoporosis were similar between patients with or without Vitamin D deficiency. After adjusting for potential confounders, there was no association between vitamin D deficiency and osteoporosis.
Conclusion:
Vitamin D deficiency and osteoporosis are highly prevalent among stroke survivors, however, there does not appear to be a relationship between the two entities.
Background:
Subsequent to recent trials of carotid artery stent placement (CAS), emergent stent placement in acute ischemic stroke is being considered more frequently as part of the endovascular treatment.
Objective:
To evaluate trends in utilization of emergent CAS in acute ischemic stroke and to compare rates of death and disability with those treated with endovascular treatment without CAS.
Methods:
We obtained data for patients admitted to hospitals in the United States between 2004 to 2009 with a primary diagnosis of ischemic stroke using the Nationwide inpatient sample, a nationally representative data of acute care hospitalizations. We determined the rate of utilization of emergent CAS as part of endovascular treatment and outcomes according to use of emergent CAS or not. Outcomes were classified as minimal disability, moderate to severe disability, and death based on discharge disposition.
Results:
Of the 12,720 patients who underwent endovascular treatment, 1000 patients had emergent CAS (mean age 65 ± 12.8 years). The estimated number of patients undergoing emergent CAS increased by 7 fold (46 in 2004 to 336 in 2009). The rates of intracranial hemorrhage remained unchanged throughout the 6 years. The rates of none-minimal disability were significantly higher (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3-3.1, p value=0.001) and in-hospital mortality was significantly lower [OR 0.6, 95% CI 0.4-0.9, p value=0.009] among patients who underwent endovascular treatment with emergent CAS after adjusting for potential confounders.
Conclusion:
There has been a significant increase in the proportion of acute ischemic stroke patients receiving emergent CAS with high rates of favorable outcomes and low rates of in-hospital mortality.
NICE willingness to pay threshold range. For both models, results were very sensitive to changes in the small estimated incremental health benefit (0.0195 versus 0.0434 quality-adjusted life-years). Intrinsic differences between both modelling approaches contributed to differences in results. Data availability issues limited replication efforts. Model execution in the cohort-level model was near-instant. Conclusions: Were a cohort-based, non-DICE modelling approach submitted by the manufacturer in TA494, this research suggests the NICE recommendation would have likely been the same. However, the model execution issues faced by the ERG and affecting committee deliberations would have been avoided. Given the number of health states required to approximate the analysis in a cohort-level model, a non-DICE patientlevel approach directly capturing patient heterogeneity may have been more apt.
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