Recurrent ischemic stroke is associated with the burden of risk factors (original) (raw)
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Recurrence of Ischemic Stroke Patients with Common Risk Factors
Bangladesh Journal of Neuroscience, 2019
Background: Mortality and morbidity due to recurrent ischemic stroke is gradually increasing in Bangladesh due to gradual increase of life expectancy. Previously many studies were done to identify the risk factors of ischemic stroke. But there was scanty data about risk factors of recurrent ischemic stroke. So,it is time demanding to find out those risk factors for ischemic stroke recurrence to reduce the mortality and morbidity from recurrent ischemic stroke. The objective of the study was to determine the frequency of recurrence ischemic stroke events within one year of follow up after discharge from hospital admitted due to first ever stroke. Methods: This is a prospective cohort study. This study was conducted on 150 patients admitted in Neurology ward of BSMMU, presenting with first ever ischemic stroke. Patients mRS were evaluated three monthly interval for one year. Sudden onset mRS deterioration than previous one during this one year period was categorized as recurrence. Res...
Clinical risk factors associated with recurrence of ischemic stroke within two years
Medicine, 2020
To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke. From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated. The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726-0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability. Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction. The clinical trial registration number: ChiCTR1800019647 Abbreviations: AUC = area under the curve, CI = confidence interval, CV DBP = diastolic pressure variation coefficient, CV SBP = systolic pressure variation coefficient, DBP = diastolic blood pressure, ESRS = Essen Stroke Risk Score, HAMD = Hamilton Depression, Hg = hydrargyrum, MAX DBP = maximum diastolic pressure, MAX SBP = maximum systolic pressure, MEAN DBP = mean diastolic pressure, MEAN SBP = mean systolic pressure, MIN DBP = minimum diastolic pressure, MIN SBP = minimum systolic pressure, MR = magnetic resonance , MRA = magnetic resonance angiography, NIHSS = National Institutes of Health Stroke Scale, OR = odds ratio, ROC = receiver operating characteristic, SBP = systolic blood pressure, SD = standard deviations.
Noro Psikiyatri Arsivi, 2015
Introduction: Disabilities due to stroke lead to a serious individual and socioeconomic burden. In this presented hospital-based study, we aimed to evaluate recurrent ischemic stroke (RIS) characteristics and the sufficiency of secondary prevention regarding the most common modifiable risk factors. Methods: The records of patients with a diagnosis of ischemic stroke between November 2009 and November 2011 in our unit were retrospectively investigated. Results: Ninety-one (18%) out of 500 patients with ischemic stroke had RIS. Hypertension, diabetes mellitus, ischemic heart disease, hyperlipidemia, atrial fibrillation, and smoking were found in 88%, 43%, 36%, 30%, 11%, and 14% of the patients, respectively. Thirty-eight percent of the patients had more than two risk factors. While 14% of the hypertensive patients did not use antihypertensive medications, antihypertensive treatment was insufficient in 39% of those who already used antihypertensive medications. Twenty-three percent of the patients received no prophylactic agents. Sixty percent of the patients with a history of atrial fibrillation were on oral anticoagulant therapy (warfarin), and the international normalized ratio was <2.0 in 73% of them. Of the diabetic patients, 87% had an HgbA1C level above 6%. The LDL level was higher than 100 mg/dL in 72% of the patients. Conclusion: The incidence of RIS and risk factors in our retrospective study was compatible with the results of those in literature. Secondary prophylactic treatment and modification of risk factors in the stroke patients were not satisfactory. The improvement of the patients' adherence to treatment is also very important in addition to the optimal treatment and follow-up strategy for decreasing the incidence of RIS. A multidisciplinary outpatient model of stroke care may be beneficial for decreasing the incidence of RIS.
The number of risk factors increases the recurrence events in ischemic stroke
European Journal of Medical Research
Purpose Stroke is a significant cause of disability worldwide and is considered a disease caused by long-term exposure to lifestyle-related risk factors. These risk factors influence the first event of stroke and recurrent stroke events, which carry more significant risks for more severe disabilities. This study specifically compared the risk factors and neurological outcome of patients with recurrent ischemic stroke to those who had just experienced their first stroke among patients admitted to the Hospital. Patients and methods We observed and analyzed 300 patients’ data who met the inclusion and exclusion criteria. This retrospective observational study was conducted on consecutive acute ischemic stroke patients admitted to the top referral hospital, West Java, Indonesia. The data displayed are epidemiological characteristics, NIHSS score at admission and discharge, and the type and number of risk factors. Data were then analyzed using appropriate statistical tests. Results Most ...
Research Square (Research Square), 2022
Background: Ischemic stroke (IS) is a heterogeneous condition with varied mechanisms. Some patients have more than one stroke mechanism underlying the incident stroke. This study aimed to examine the association of dual stroke mechanisms among ischemic stroke patients with risk factors and clinical outcomes. Methods: Case records of adult patients with IS diagnosed using TOAST criteria in a University Stroke-Registry were reviewed for presence of dual IS mechanisms-viz. combinations involving small vessel disease(SVD), cardio-embolism(CE), or large artery atherosclerosis(LA). Outcomes were classi ed as good (modi ed Rankin Score=0-3) or poor (4-6). Univariate and multivariate methods of analysis were used. Results: Among 1220 patients with IS (age: 64+13 years; M:F::63%:37%), 177(14.5%) had an additional mechanism of stroke. SVD(51%) was the most common second mechanism, while CE(23%) and LA stroke(25%) were similar in frequency. On univariate analysis, patients with dual stroke mechanisms were signi cantly older(p<0.001), had higher frequency of conventional risk factors (p<0.007), abnormal brain MRI(p=0.004) and worse outcomes(p=0.058). On logistic regression analysis, poor outcomes at hospital discharge or 12 month follow-up were independently associated with: older age(p=0.007); female gender(p=0.017); poor sensorium(p<0.001); and type of primary stroke(p<0.001). Conclusions: Up to one in seven patients with ischemic stroke may have an additional mechanism of stroke. Such patients are likely older, with poorly controlled risk factors, worse sensorium and possible worse outcomes. Small vessel disease is the most common additional stroke mechanism. Studies to explore the in uence of dual stroke mechanisms on outcomes as well strategies for secondary prevention are indicated.
Risk factors for early recurrence after ischemic stroke: the role of stroke syndrome and subtype
Stroke; a journal of cerebral circulation, 1998
Information regarding risk factors for early recurrence is limited. Our aim was to identify the clinical predictors of early recurrence after ischemic stroke. We prospectively examined 297 patients (mean age, 72.0+/-8.4 years) hospitalized with ischemic stroke to identify recurrent strokes occurring within 90 days of the index stroke. Survival free of recurrence was estimated using Kaplan-Meier analysis stratified by demographic variables; vascular risk factors; stroke syndrome, subtype, vascular territory, and severity; scores on the Barthel Index and Mini-Mental State Examination during hospitalization; blood pressure on admission; and selected laboratory data. We estimated the relative risk (RR) of early recurrence associated with those variables using proportional hazards analysis. We identified 22 recurrent events in the first 90 days after the index stroke, resulting in an early stroke recurrence rate of 7.4%, and death occurred immediately after recurrence in 6 of the 22 pati...
Risk factors and subtypes of acute ischemic stroke. A study at King Fahd Hospital of the University
Neurosciences, 2016
Objective: To identify the different subtypes of acute ischemic stroke, and estimate the frequency of various risk factors among these patients. Neurosciences 2016; Vol. 21)3(Methods: In this retrospective, cross-sectional study, we reviewed the medical records of patients admitted with the diagnosis of acute ischemic stroke at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia from March 2008 till December 2015. The demographic characteristics, subtypes of stroke, risk factors)hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, atrial fibrillation, valvular heart disease(and other relevant data were documented on pre-defined data sheets. Results: The records of 343 patients were included in the study; 64.4% were male and 35.6% were female. The mean age was 59.3+13.6)mean+SD(years for males, and 66.8+14.9 years for females. Small vessel occlusion was the most common etiologic subtype of ischemic stroke)32.1%(, followed by cardio embolic)21.9%(, and large artery atherosclerosis)14.6%(. The middle cerebral artery was the most commonly affected territory. Hypertension was found in 78.1%, diabetes mellitus in 62.7%, hyperlipidemia in 54.8%, and ischemic heart disease in 24.2% of patients. Conclusion: Small vessel occlusion was the most common etiology in our cohort. The onset of stroke at a relatively younger age group in the male population is of great concern and needs to be verified by further epidemiological studies. Adequate control of modifiable risk factors may help in reducing the disease burden caused by stroke.
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2018
Background: Acute ischemic stroke is one of the major causes of disability and death worldwide. Effective prevention remains the best approach for reducing the burden of stroke. The aim of this work was to study the prevalence of stroke risk factors and the possible relation between such risk factors and the disease severity at presentation in a sample of stroke patients presented to Beni-Suef University Hospital, north Upper Egypt. Methods: A sample of 167 patients of acute ischemic stroke recruited from Beni-Suef University Hospital was included in this cross-sectional descriptive study. All subjects were subjected to history taking, clinical, laboratory, and radiological evaluation. Stroke severity and disability were evaluated by National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) respectively. Results: Hypertension was detected in 104 patients (62.3%), dyslipidemia was detected in 79 patients (58.1%), and 69 patients (41.3%) were smokers. Diabetes mellitus was detected in 58 patients (34.7%) with high prevalence of cardio-embolic risk factor, 36 patients (21.6%) had rheumatic heart, and 44 patients (26.3%) had atrial fibrillation. NIHSS score was significantly higher in hypertensive patients (P value = 0.023) and in patients who had carotid stenosis ≥ 50% (P value = 0.011), whereas there was no significant relation between NIHSS score and diabetes mellitus (P = 0.221), dyslipidemia (P = 0.834), patients with history of cardio-embolic stroke (P = 0.085), previous ischemic stroke (P = 0.316), or sex (P = 0.343). mRS score was significantly higher in patients with age > 45 years old (P < 0.001), hypertension (P < 0.001), cardio-embolic risk factor (P = 0.044), and carotid stenosis ≥ 50% (P = 0.017), whereas there was no significant relation between mRS score and diabetes mellitus, previous ischemic stroke, or sex. Conclusions: The most common risk factor for stroke was hypertension followed by dyslipidemia and then smoking with higher incidence of rheumatic heart diseases due to lowered living conditions. Age, hypertension, cardio-embolic risk factors, and carotid stenosis ≥ 50% have negative impact on stroke severity and disability.