Role of dyslipidemia in ischemic stroke patients treated in the telestroke network

Brechtel, Leanne; Poupore, Nicolas; Monroe, Margaret A.; Knisely, Krista; Sanders, Carolyn Breauna; Edrissi, Camron; Rathfoot, Chase; Nathaniel, Thomas I.

doi:10.1016/j.advms.2021.04.003

Cited by 6 publications

(5 citation statements)

References 34 publications

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“…In the adjusted analysis for AIS patients without HF, we observed that patients that received rtPA presented with a history of previous TIA, elevated cholesterol levels, and direct admission to a primary stroke center for treatment. Similar findings have been reported for AIS patients with histories of previous TIA, 21 – 23 elevated cholesterol levels, 13 , 24 and direct admission. 25 , 26 We also observed that AIS patients without HF who did not receive rtPA were more likely to be Hispanic and present with coronary artery stenosis, previous stroke, and elevated lipid level, creatinine, INR, and heart rate.…”

Section: Discussionsupporting

confidence: 88%

Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy

Sanders

Knisely

Rathfoot

et al. 2022

Clin Appl Thromb Hemost

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Objective: Acute ischemic stroke (AIS) patients with congestive heart failure (HF) that present with various risk factors are less likely to receive recombinant tissue plasminogen activator (rtPA). The risk factors associated with excluding AIS patients with congestive heart failure (AIS-HF) from rtPA therapy have not been fully established. Methods: Retrospective data for 5469 AIS patients comprised of 590 AIS patients with HF and 4879 AIS patients without HF were collected from a regional stroke registry between January 2010 and June 2016. Baseline risk factors were analyzed using logistic regression analysis to determine the risk factors associated with rtPA exclusion in AIS-HF patients. Results: In the adjusted analysis, AIS-HF patients that that did not receive rtPA were more likely to be older (OR = 0.982, 95% CI, 0.966-1, P = .020), presented with coronary artery disease (OR = 0.618, 95% CI, 0.391-0.98, P = .040), and with an elevated INR (OR = 0.326, 95% CI, 0.129-0.82, P = .018). AIS-HF patients that were included for rtPA therapy were more likely to show improvement in ambulatory status (OR = 1.69, 95% CI, 1.058-2.7, P = .028). The discriminating power of the model was strong with an area under the curve (AUROC) = 0.668 (95% CI, 0.611-0.724, P < .001). Conclusion: Our study establishes the associations between stroke risk factors and exclusion from rtPA therapy. This finding suggests the need to develop management strategies for older HF patients with carotid artery disease and an elevated INR to improve their eligibility for rtPA treatment following an acute ischemic stroke.

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Section: Discussionsupporting

confidence: 88%

Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy

Sanders

Knisely

Rathfoot

et al. 2022

Clin Appl Thromb Hemost

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“…Some studies have argued that BMI is an independent predictor of improved survival even after adjusting for the effects of age and gender. In support of this, many studies have reported that a population with increased BMI received more efficient medical care compared with those with a normal BMI [ 15 ]. Obese patients are reported to present with higher metabolic reserves, and this may benefit them in critical health conditions [ 51 ].…”

Section: Discussionmentioning

confidence: 94%

“…In some studies, neither SBP nor DBP predicted stroke severity [ 11 , 13 ], whereas, in others, only SBP [ 8 , 12 ] or DBP [ 3 , 14 ] was associated with worse neurologic outcomes. Recent clinical trials have mainly focused on SDP in reducing vascular risk [ 3 , 15 ]. However, little is known about the relationship between DBP level with severity after a stroke.…”

Section: Introductionmentioning

confidence: 99%

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network

Brown

Terrell

Goodwin

et al. 2022

JCDD

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Background: The relationship between diastolic blood pressure (DBP), risk factors, and stroke severity in acute ischemic stroke (AIS) patients treated in a telestroke network is not fully understood. The present study aims to determine the effect of risk factors on stroke severity in AIS patients with a history of elevated DBP. Material and Methods: We retrospectively analyzed data on stroke severity for AIS patients treated between January 2014 and June 2016 treated in the PRISMA Health telestroke network. Data on the severity of stroke on admission were evaluated using NIHSS scores ≤7 for reduced, and >7 for increased, stroke severity. DBP was stratified as ≤80 mmHg for reduced DBP and >80 mmHg for elevated DBP. The study’s primary outcomes were risk factors associated with improving neurologic functions or reduced stroke severity and deteriorating neurologic functions or increased stroke severity. The associations between risk factors and stroke severity for AIS with elevated DBP were determined using multi-level logistic and regression models. Results: In the adjusted analysis, AIS patients with a DBP ≤ 80 mmHg, obesity (OR = 0.388, 95% Cl, 0.182–0.828, p = 0.014) was associated with reduced stroke severity, while an increased heart rate (OR = 1.025, 95% Cl, 1.001–1.050, p = 0.042) was associated with higher stroke severity. For AIS patients with a DBP > 80 mmHg, hypertension (OR = 3.453, 95% Cl, 1.137–10.491, p = 0.029), history of smoking (OR = 2.55, 95% Cl, 1.06–6.132, p = 0.037), and heart rate (OR = 1.036, 95% Cl, 1.009–1.064, p = 0.009) were associated with higher stroke severity. Caucasians (OR = 0.294, 95% Cl, 0.090–0.964, p = 0.002) and obesity (OR = 0.455, 95% Cl, 0.207–1.002, p = 0.05) were more likely to be associated with reduced stroke severity. Conclusions: Our findings reveal specific risk factors that can be managed to improve the care of AIS patients with elevated DBP treated in the telestroke network.

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“…The few studies [47,48] that evaluated the association between serum TGLs and outcomes in AIS reported diverse associations, and lower total triglyceride levels were reported to be associated with a worse prognosis in AIS. While patients with end-stage heart failure are reported to present with low TGLs [49,50], a normal range of TGL is regarded to be too low for these patients [51,52]. Triglyceride levels have been shown to drop substantially during extreme stress as this is the metabolically active form of cholesterol [53].…”

Section: Discussionmentioning

confidence: 99%

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

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Role of dyslipidemia in ischemic stroke patients treated in the telestroke network

Cited by 6 publications

References 34 publications

Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy

Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

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