Cardiovascular Risk in Survivors of Stroke

Kopunek, Susan; Michael, Kathleen M.; Shaughnessy, Marianne; Resnick, Barbara; Nahm, Eun-Shim; Whitall, Jill; Goldberg, Andrew P.; Macko, Richard F.

doi:10.1016/j.amepre.2007.01.021

Cited by 33 publications

(29 citation statements)

References 19 publications

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“…It is also well known that stroke patients have impaired cardiovascular health [30][31]. We found that poorer cardiovascular fitness, as reflected by lower peak VO 2 , was independently associated with lower BMD, less favorable bone geometry, and hence, lower tibial BSI on both sides.…”

Section: Cardiovascular Fitness and Muscle Mass Are Associated With Bsisupporting

confidence: 47%

Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

2009

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Purpose-To identify the determinants of the bone strength index (BSI) at the distal tibia in chronic stroke patients.Methods-Sixty-three chronic stroke survivors underwent scanning of the distal tibia at the 4% site on both sides using peripheral quantitative computed tomography. The primary outcomes were trabecular bone mineral density (BMD) (mg/cm 3 ), total BMD (mg/cm 3 ), total bone area (mm 2 ), and BSI (g 2 /cm 4 ). Cardiovascular fitness, leg lean mass, gait velocity, and spasticity were also measured.Results-Scans from 45 subjects were deemed to have acceptable quality and were included for subsequent analysis. The paretic side had significantly lower trabecular BMD, total BMD, and BSI than the non-paretic side (p<0.05). However, the total bone area demonstrated no significant sideto-side difference (p>0.05). After adjusting for relevant biological factors, peakoxygen consumption, leg muscle mass, gait velocity remained positively associated with tibial BSI on both sides (R 2 change=6.9-14.2%), whereas spasticity of the paretic leg was negatively associated with tibial BSI on the same side (R 2 change=4.8%).Conclusions-Cardiovascular function, muscle atrophy, mobility, and spasticity are independently associated with BSI of the distal tibia epiphysis among chronic stroke patients.

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Section: Cardiovascular Fitness and Muscle Mass Are Associated With Bsisupporting

confidence: 47%

Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

2009

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“…Autonomic function is also altered post-stroke, where impairments in baroreflex function and BP control may result in inadequate cerebral perfusion (Sykora et al, 2009,Kong and Chuo, 2003. Given these issues, as well as the prevalence of cardiovascular co-morbidities among individuals with stroke (Kopunek et al, 2007,Roth, 1993 and elevated risk for recurrent events (Mohan et al, 2011), it is important to identify people with stroke who also present with OH.…”

Section: Introductionmentioning

confidence: 99%

“…While this cohort has typically completed active rehabilitation interventions, they continue to be at risk for functional decline (Paolucci et al, 2001,van de Port et al, 2006, cardiovascular risk factors remain poorly managed (Kopunek et al, 2007) and falls that occur with OH-related syncope may increase the risk of injuries, such as hip fractures (Gill et al, 2009). Thus, it is important to routinely screen for the presence of autonomic dysfunction in this vulnerable population and prevent potential complications.…”

Section: Introductionmentioning

confidence: 99%

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Tang

Eng

Krassioukov

2012

Autonomic Neuroscience

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Orthostatic hypotension (OH) is an important consideration for individuals with stroke, given the shared occurrence of mobility limitations, fall risk and association with adverse cardiovascular outcomes. This study aimed to 1) establish the application of a simple bedside test of orthostatic challenge to identify OH after stroke, 2) examine differences in characteristics between those with and without OH and 3) determine cardiovascular correlates with hemodynamic responses. Fortynine participants (n=29 men, mean±SD age 66±7 years, time post-stroke 4.5±3.1 years) performed an orthostatic challenge (Sit-Up Test). Eleven (22%) of the 49 participants presented with OH (n=7, of which 5 were asymptomatic) or symptoms of cerebral hypoperfusion with position change (n=4). Compared to participants without OH, those with OH had higher total:high-density lipoprotein cholesterol ratios (4.2 ± 0.9 vs. 3.3 ± 0.8, P=0.009) and triglyceride levels (2.2 ± 0.8 vs. 1.4 ± 0.5 mmol/L, P=0.001). Multivariate linear regression revealed that high-density lipoprotein cholesterol and triglyceride levels explained 20% of the variance of the change in systolic blood pressure from the Sit-Up Test (F(2,45)=5.68, P=0.006). In conclusion, we used a simple bedside test of orthostatic tolerance to identify that over 20% of individuals with stroke presented with OH or symptoms of hypoperfusion. They also had more impaired cardiovascular risk profiles relative to those without OH. These individuals may be at even higher risk for mobility limitations and falls beyond that associated with stroke-related deficits alone.

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“…12 Whether arterial stiffness remains elevated in the later poststroke stages is also important, because the risk for recurrent events remains high; the 5-year rate for recurrent stroke is 26% and at 10 years is nearly 40%. 15 Cardiovascular risk factors are poorly managed in the later stages after stroke, 16 and comorbid cardiovascular conditions, such as hypertension and heart disease, are highly prevalent. 17 In addition, mobility limitations that persist after the initial neuromotor sequelae from stroke often lead to long-term inactivity and sedentary behaviors.…”

mentioning

confidence: 99%

Physical Activity Correlates with Arterial Stiffness in Community-dwelling Individuals with Stroke

Tang

Eng

Brasher

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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Background-Physical inactivity contributes to atherosclerotic processes, which manifest as increased arterial stiffness. Arterial stiffness is associated with myocardial demand and coronary perfusion and is a risk factor for stroke and other adverse cardiac outcomes. Poststroke mobility limitations often lead to physical inactivity and sedentary behaviors. This exploratory study aimed to identify functional correlates, reflective of daily physical activity levels, with arterial stiffness in community-dwelling individuals >1 year poststroke.

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Cardiovascular Risk in Survivors of Stroke

Cited by 33 publications

References 19 publications

Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Physical Activity Correlates with Arterial Stiffness in Community-dwelling Individuals with Stroke

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