A Systematic Comparison of the Quality and Volume of Published Data Available on Novel Risk Factors for Stroke versus Coronary Heart Disease

Bhatia, Meena; Rothwell, Peter M.

doi:10.1159/000087202

Cited by 20 publications

(14 citation statements)

References 132 publications

(97 reference statements)

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“…There is a relative lack of published data on risk factors for stroke compared with coronary events [38]. Data on apoB and apoA‐1 in relation to ischaemic stroke are so far limited and previous studies have been conflicting.…”

Section: Discussionmentioning

confidence: 99%

Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

Holme¹,

Aastveit

Hammar

et al. 2009

Journal of Internal Medicine

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Objectives. To compare lipoprotein components associated with ischaemic and haemorrhagic stroke by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study (n = 148 600).Design. Prospective follow-up study (11.8, range 7-17 years) of fatal and nonfatal ischaemic and haemorrhagic stroke through linkage with Swedish hospital discharge and mortality registers.Setting. Measurements of lipoprotein components from health check-ups in the larger Stockholm area.Results. Ischaemic stroke was more common than haemorrhagic stroke (5 : 1), but case fatality was higher in haemorrhagic stroke. An elevated apoB ⁄ apoA-1 ratio and triglycerides, non-HDL cholesterol, low HDL cholesterol, and the total cholesterol to high-density cholesterol (TC ⁄ HDL-C) ratio were associated with increased incidence of nonfatal and fatal ischaemic stroke as well as all cerebrovascular events (n = 7480) in both genders. The associations were somewhat stronger for nonfatal than fatal events. In ischaemic stroke the apoB ⁄ apoA-1 ratio was a stronger predictor than the TC ⁄ HDL-C ratio in all subjects, in those below 65 years of age and in those with LDL-C below 3 mmol L )1 . Haemorrhagic stroke was not associated with elevated atherogenic lipoproteins except for increased risk of fatal haemorrhagic stroke in women with a high apoB ⁄ apoA-I ratio.Conclusions. Dyslipidaemia is associated with an increased risk of ischaemic stroke but few relations were seen in haemorrhagic stroke. Use of the apoB ⁄ apoA-I ratio as a marker of dyslipidaemia is at least as efficient as conventional lipids, for the identification of subjects at increased risk of stroke, especially ischaemic stroke. Practical advantages, fasting is not needed, speak in favour of using apoB and apoA-1 in stroke risk prediction.

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Section: Discussionmentioning

confidence: 99%

Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

Holme¹,

Aastveit

Hammar

et al. 2009

Journal of Internal Medicine

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“…Elevated CRP levels have been consistently found after ischemic stroke and are associated with an increased risk of cerebrovascular and cardiovascular events in ischemic stroke patients [for a review, see [23],[ 26],[ 27]]. CRP is mostly produced by liver hepatocytes in response to cytokines such as interleukin 1, interleukin 6 and tumor necrosis factor [28].…”

Section: Discussionmentioning

confidence: 99%

C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

et al. 2009

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Background: The aim of the current study was to assess the occurrence of infection and its impact on the short- and long-term outcome of patients with supratentorial intracerebral hemorrhage (ICH). Methods: 247 patients suffering from supratentorial ICH were extracted from our local stroke database. Complete data sets including long-term functional outcome measured by the modified Rankin Scale (mRS), and baseline computed tomography data could be obtained in 113. The charts of these patients were screened for the presence and cause of infection, and baseline and maximal C-reactive protein (CRP) levels were recorded. Results: We identified 52 patients (50.5%) with infection during their hospital stay. Patients with infection, had significantly larger hemorrhages (28.7 vs. 11.9 ml; p = 0.002), a poorer admission status (National Institutes of Health Stroke Scale, NIHSS, score 14 vs. 6; p = 0.002) and more frequently intraventricular hemorrhage extension (46.2 vs. 23.5%; p = 0.016) than those without infection. In a multivariate logistic regression model, baseline NIHSS score (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1–1.31, p < 0.001), age (OR 1.1, 95% CI 1.03–1.16, p = 0.002) and maximal CRP levels (OR 1.72, 95% CI 1.12–2.64, p = 0.013) were independent predictors of poor long-term functional outcome (mRS >2). Conclusion: Infections were frequent complications in our cohort of ICH patients and occurred significantly more often in patients with poor functional outcome. Maximal CRP levels were an independent predictor of poor outcome in a multivariate model.

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“…Epidemiological studies on stroke present more challenges than those in CHD [42] . Although stroke is defined and diagnosed clinically [43] , objective investigation with CT or MRI is essential for establishing a valid distinction between ischemic and hemorrhagic stroke.…”

Section: Limited Global Stroke Epidemiologymentioning

confidence: 99%

Rationale and Design of INTERSTROKE: A Global Case-Control Study of Risk Factors for Stroke

et al. 2010

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Stroke is a major global health problem. It is the third leading cause of death and the leading cause of adult disability. INTERHEART, a global case-control study of acute myocardial infarction in 52 countries (29,972 participants), identified nine modifiable risk factors that accounted for >90% of population-attributable risk. However, traditional risk factors (e.g. hypertension, cholesterol) appear to exert contrasting risks for stroke compared with coronary heart disease, and the etiology of stroke is far more heterogeneous. In addition, our knowledge of risk factors for stroke in low-income countries is inadequate, where a very large burden of stroke occurs. Accordingly, a similar epidemiological study is required for stroke, to inform effective population-based strategies to reduce the risk of stroke. Methods: INTERSTROKE is an international, multicenter case-control study. Cases are patients with a first stroke within 72 h of hospital presentation in whom CT or MRI is performed. Proxy respondents are used for cases unable to communicate. Etiological and topographical stroke subtype is documented for all cases. Controls are hospital- and community-based, matched for gender, ethnicity and age (±5 years). A questionnaire (cases and controls) is used to acquire information on known and proposed risk factors for stroke. Cardiovascular (e.g. blood pressure) and anthropometric (e.g. waist-to-hip ratio) measurements are obtained at the time of interview. Nonfasting blood samples and random urine samples are obtained from cases and controls. Study Significance: An effective global strategy to reduce the risk of stroke mandates systematic measurement of the contribution of the major vascular risk factors within defined ethnic groups and geographical locations.

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A Systematic Comparison of the Quality and Volume of Published Data Available on Novel Risk Factors for Stroke versus Coronary Heart Disease

Cited by 20 publications

References 132 publications

Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS)

C-Reactive-Protein Levels Associated with Infection Predict Short- and Long-Term Outcome after Supratentorial Intracerebral Hemorrhage

Rationale and Design of INTERSTROKE: A Global Case-Control Study of Risk Factors for Stroke

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