Emerging Risk Factors for Stroke

Hopewell, Jemma C.; Clarke, Robert

doi:10.1161/strokeaha.115.010646

Cited by 24 publications

(14 citation statements)

References 51 publications

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“…It was also outside the scope of this review to discuss non-blood-based emerging risk factors for vascular disease, such as radiation, coronary artery calcification, carotid intima-media thickness, carotid plaque and ankle-brachial index [10]. For a recent wide-ranging review of emerging risk factors for stroke see Hopewell and Clarke [6•].…”

Section: Limitations Of Reviewmentioning

confidence: 99%

“…Major risk factors for cardiovascular disease include, but are not limited to, cigarette smoking, blood pressure, blood lipids, diabetes mellitus and adiposity [1–5, 6•]. The causality of these ‘classic’ risk factors is well established and they are commonly used to assess absolute cardiovascular risk in the general population [7–9].…”

Section: Introductionmentioning

confidence: 99%

“…The causality of these ‘classic’ risk factors is well established and they are commonly used to assess absolute cardiovascular risk in the general population [7–9]. Over the last few decades, however, other risk factors (commonly blood-based biomarkers) have been identified with potentially important implications for cardiovascular disease prevention, either through improved risk prediction or for treating cardiovascular disease (Table 1) [6•, 10]. For many of these risk factors, their causal relevance to cardiovascular disease is not well established and research is ongoing.…”

Section: Introductionmentioning

confidence: 99%

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The Role of Emerging Risk Factors in Cardiovascular Outcomes

Lacey

Herrington

Preiss

et al. 2017

Curr Atheroscler Rep

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Purpose of ReviewThis review discusses the recent evidence for a selection of blood-based emerging risk factors, with particular reference to their relation with coronary heart disease and stroke.Recent FindingsFor lipid-related emerging risk factors, recent findings indicate that increasing high-density lipoprotein cholesterol is unlikely to reduce cardiovascular risk, whereas reducing triglyceride-rich lipoproteins and lipoprotein(a) may be beneficial. For inflammatory and hemostatic biomarkers, genetic studies suggest that IL-6 (a pro-inflammatory cytokine) and several coagulation factors are causal for cardiovascular disease, but such studies do not support a causal role for C-reactive protein and fibrinogen. Patients with chronic kidney disease are at high cardiovascular risk with some of this risk not mediated by blood pressure. Randomized evidence (trials or Mendelian) suggests homocysteine and uric acid are unlikely to be key causal mediators of chronic kidney disease-associated risk and sufficiently large trials of interventions which modify mineral bone disease biomarkers are unavailable. Despite not being causally related to cardiovascular disease, there is some evidence that cardiac biomarkers (e.g. troponin) may usefully improve cardiovascular risk scores.SummaryMany blood-based factors are strongly associated with cardiovascular risk. Evidence is accumulating, mainly from genetic studies and clinical trials, on which of these associations are causal. Non-causal risk factors may still have value, however, when added to cardiovascular risk scores. Although much of the burden of vascular disease can be explained by ‘classic’ risk factors (e.g. smoking and blood pressure), studies of blood-based emerging factors have contributed importantly to our understanding of pathophysiological mechanisms of vascular disease, and new targets for potential therapies have been identified.

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Section: Limitations Of Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of Emerging Risk Factors in Cardiovascular Outcomes

Lacey

Herrington

Preiss

et al. 2017

Curr Atheroscler Rep

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“…Stroke and falls have a large impact on society. Stroke is the second largest cause of death and the leading source of disability, 1 and the lasting neurological symptoms of stroke could increase the risk of falls. 2 3 It is well established that falls are associated with increased morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

A History of Falls is Associated with a Significant Increase in Acute Mortality in Women after Stroke

et al. 2017

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Background and PurposeThe risks of falls and fractures increase after stroke. Little is known about the prognostic significance of previous falls and fractures after stroke. This study examined whether having a history of either event is associated with poststroke mortality.MethodsWe analyzed stroke register data collected prospectively between 2003 and 2015. Eight sex-specific models were analyzed, to which the following variables were incrementally added to examine their potential confounding effects: age, type of stroke, Oxfordshire Community Stroke Project classification, previous comorbidities, frailty as indicated by the prestroke modified Rankin Scale score, and acute illness parameters. Logistic regression was applied to investigate in-hospital and 30-day mortality, and Cox proportional-hazards models were applied to investigate longer-term outcomes of mortality.ResultsIn total, 10,477 patients with stroke (86.1% ischemic) were included in the analysis. They were aged 77.7±11.9 years (mean±SD), and 52.2% were women. A history of falls was present in 8.6% of the men (n=430) and 20.2% of the women (n=1,105), while 3.8% (n=189) of the men and 12.9% of the women (n=706) had a history of both falls and fractures. Of the outcomes examined, a history of falls alone was associated with increased in-hospital mortality [odds ratio (OR)=1.33, 95% confidence interval (CI)=1.03–1.71] and 30-day mortality (OR=1.34, 95% CI=1.03–1.73) in women in the fully adjusted models. The Cox proportional-hazards models for longer-term outcomes and the history of falls and fractures combined showed no significant results.ConclusionsThe history of falls is an important factor for acute stroke mortality in women. A previous history of falls may therefore be an important factor to consider in the short-term stroke prognosis, particularly in women.

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“…[ 10 ] In addition, the genetic score, we constructed could combine information from multiple variants that associated with the CRP, and could maximize power and avoid the weak instrument bias. [ 11 ]…”

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confidence: 99%