Cardiac evaluation of stroke patients

Wilterdink, Janet L; Furie, Karen L.; Easton, J D

doi:10.1212/wnl.51.3_suppl_3.s23

Cited by 32 publications

(22 citation statements)

References 12 publications

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“…Longer follow-up periods would provide more precise estimates of 10-year cumulative risk, but our 5-year risk data provide evidence that the long-term risk of MI and vascular death is as high after ischemic stroke as the risk of coronary risk equivalents. Because survivors of ischemic stroke may be more likely to die of cardiac causes than of recurrent stroke, 19,20,21 our data reinforces the urgency of focusing on cardioprotective, as well as cerebroprotective, therapies in this patient population. Lacunar stroke patients had a lower risk of subsequent MI and vascular death in our population, although even in this lower risk group, risk approached the level of a coronary risk equivalent.…”

Section: Dhamoon Et Al Cardiovascular Risk After Strokesupporting

confidence: 66%

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Dhamoon

Tai

Boden‐Albala

et al. 2007

Stroke

124

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Background and Purpose-In national guidelines, absolute long-term risk of myocardial infarction (MI) or coronary death determines target low-density lipoprotein levels, but stroke patients are not explicitly addressed. We determined the absolute 5-year risk of cardiovascular outcomes and their predictors after first ischemic stroke in a multiethnic cohort. Methods-A population-based cohort of first ischemic stroke patients Ն40 years old was prospectively followed annually for recurrent stroke, MI and cause-specific mortality. Kaplan-Meier 5-year risks for MI or vascular death (primary outcome), and other cardiovascular events, were calculated. Univariate and multivariate Cox proportional hazards models were used to calculate hazard ratios and 95% CI for predictors of cardiovascular outcomes. Results-Mean age (nϭ655) was 69.7Ϯ12.7 years; 55.4% of participants were women, and 51.3% Hispanic. The 5-year risk of MI or vascular death was 17.4% (95% CI, 14.2% to 20.6%). Independent historical predictors of MI or vascular death were age Ͼ70 years (hazard ratio 1.62, 1.07 to 2.44), history of coronary artery disease (hazard ratio 1.76, 1.13 to 2.74), and atrial fibrillation (hazard ratio 1.76, 1.05 to 2.94). In the lowest risk group, those Յ70 years old without coronary artery disease, 5-year risk of MI or vascular death was 9.7%. Conclusions-The absolute risk of MI or vascular death after ischemic stroke, even in those without high-risk features, approximates levels used by national organizations to designate groups of patients at high risk of vascular events. The comparability of levels of absolute risk among stroke and cardiac patients may have treatment implications. (Stroke.

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Section: Dhamoon Et Al Cardiovascular Risk After Strokesupporting

confidence: 66%

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Dhamoon

Tai

Boden‐Albala

et al. 2007

Stroke

124

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“…According to this hypothesis, previous reported series and clinical trials have demonstrated that patients with cerebrovascular disease are more likely to die in follow-up from cardiovascular than from cerebrovascular causes. 37,38 In this study, we have found an age-dependent increase in serum chitotriosidase activity. A similar effect of age on chitotriosidase activity has been previously described in subjects with different lysosomal disorders and in the general population.…”

Section: Discussionsupporting

confidence: 56%

Serum Chitotriosidase Activity Is Increased in Subjects With Atherosclerosis Disease

Artieda

Cenarro²,

Gañán³

et al. 2003

ATVB

115

114

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Objective-This study was undertaken to analyze the relation between serum activity of chitotriosidase enzyme, a protein synthesized exclusively by activated macrophages, and atherosclerotic lesion extent in subjects with atherothrombotic stroke (ATS) and in subjects with ischemic heart disease (IHD). Methods and Results-We assayed the serum chitotriosidase activity and a common chitotriosidase gene polymorphism that causes deficiency in chitotriosidase activity in 3 Spanish populations, ATS (nϭ153), IHD (nϭ124), and control (nϭ148) subjects. Statistical differences were found in serum chitotriosidase activity between ATS (88.1Ϯ4.6 nmol/mL · h, PϽ0.0001) and IHD subjects (79.0Ϯ6.3, Pϭ0.002) versus control group (70.9Ϯ5.2). These observed differences were not attributable to a distinct allelic or genotype distribution. The extension of the atherosclerotic lesion in carotids of ATS subjects was measured by duplex sonography. Chitotriosidase activities were 66.9Ϯ9.6, 88.7Ϯ8.3, and 107.7Ϯ11.8 for subjects with carotid stenosis Յ30%, 31% to 60%, and Ͼ60%, respectively. Statistical differences were observed between subjects with major and intermediate stenosis grade compared with subjects with minor stenosis, Pϭ0.005 and Pϭ0.016, respectively. Conclusions-Serum chitotriosidase activity is significantly increased in individuals suffering from atherosclerosis disease and is related to the severity of the atherosclerotic lesion, suggesting a possible role as atherosclerotic extent marker.

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“…Since it appears that polyvascular disease has a more aggressive risk profile, it is likely to require more intensive medical therapy. 3,[18][19][20] The problem posed by polyvascular disease is likely to be underestimated for several reasons. One contributing factor is the frequent underdiagnosis of PAD, 10 caused by its asymptomatic presentation in twothirds of patients.…”

Section: Discussionmentioning

confidence: 99%

Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH Registry

Suárez

Zeymer²,

Limbourg

et al. 2010

Vasc Med

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Cardiovascular event rates have been shown to increase substantially with the number of symptomatic disease locations. We sought to assess the risk profile, management and subsequent event rates of polyvascular disease patients. Consecutive outpatients were assessed for atherosclerotic risk factors and medications in the REACH Registry. A total of 19,117 symptomatic patients in Europe completed a 2-year follow-up: 77.2% with single arterial bed disease (coronary artery or cerebrovascular or peripheral arterial disease) and 22.8% with polyvascular disease (≥ 1 disease location). Polyvascular disease patients were older (68.5 ± 9.4 vs 66.3 ± 9.9 years, p < 0.0001), more often current or former smokers (64.9% vs 58.7%, p < 0.0001), and more often suffered from hypertension (59.5% vs 46.6%, p < 0.0001) and diabetes (34.5% vs 25.9%, p < 0.0001) than single arterial bed disease patients. Despite more intense medical therapy, risk factors (smoking, hypertension, low fasting glucose, and low fasting total cholesterol) were less often controlled in polyvascular disease patients. This was associated with substantially more events over 2 years compared with single arterial bed disease patients (cMACCE [cardiovascular death/non-fatal stroke/non-fatal MI] odds ratio, 1.63 [95% CI, 1.45—1.83], p < 0.0001). In conclusion, polyvascular disease patients have more cardiovascular risk factors, and the prognosis for these patients is significantly worse than for patients with single arterial bed disease. This suggests a need to improve detection and consequent medical treatment of polyvascular disease.

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Cardiac evaluation of stroke patients

Cited by 32 publications

References 12 publications

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Serum Chitotriosidase Activity Is Increased in Subjects With Atherosclerosis Disease

Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH Registry

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