Background: The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual’s risk of atherosclerotic vascular disease. The authors evaluated the prevalence and pro...Background: The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual’s risk of atherosclerotic vascular disease. The authors evaluated the prevalence and prognosis of the MetS among individuals with symptomatic intracranial arterial stenosis. Methods: Patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease trial were evaluated in this post-hoc analysis. Baseline characteristics and outcome were compared in patients with the MetS vs patients without the MetS. Results: Among 476 patients, the prevalence of the MetS was 43%. MetS patients were more likely to be younger, female, and white. During a mean follow-up period of 1.8 years, time to the first of ischemic stroke, myocardial infarction, or vascular death was shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.6 (95%CI = 1.1 to 2.4, p = 0.0097). Time to ischemic stroke alone was also shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.7 (95%CI = 1.1 to 2.6, p = 0.012). When controlling for individual factors of the definition, MetS was not significant (combined outcome: p = 0.14; ischemic stroke: p = 0.074). Conclusions: The metabolic syndrome is present in about half of individuals with symptomatic intracranial atherosclerotic disease and is associated with a substantially higher risk of major vascular events. The metabolic syndrome may not provide additional ability to predict outcomes beyond the individual factors for patients with intracranial stenosis.展开更多
Smokers with acute myocardial infarction have better outcomes after thrombolysis than nonsmokers. The authors evaluated the independent effect of smoking on short-term outcome following IV thrombolysis for acute ische...Smokers with acute myocardial infarction have better outcomes after thrombolysis than nonsmokers. The authors evaluated the independent effect of smoking on short-term outcome following IV thrombolysis for acute ischemic stroke. After adjusting for covariates, recent smokers who received thrombolysis had a significantly greater drop in 24-hour median stroke severity scores from baseline than nonsmokers who received thrombolysis and lower mortality over 1 year.展开更多
Objective: To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its ei ght secondary prevention goals at the time of discharge. M...Objective: To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its ei ght secondary prevention goals at the time of discharge. Methods: Achievement ra tes for the eight program goals at time of discharge were compared in all patien ts discharged from a university hospitalbased stroke service with a diagnosis of ischemic st roke or TIA during a 1 year period after implementation of the PROTECT Program vs rates obtained from a comparable group of patients admitted to the same servi ce during the preceding year. Results: Demographic and medical features were com parable in the baseline and intervention cohorts for all patients with cerebral ischemia presumed due to large vessel atherosclerosis or small vessel disease (baseline year n = 117, intervention n = 130). Implementation rates in patients without specific contraindications increased for all four medication goals: 97 t o 100%for antithrombotic agents, 68 to 97%for statins, 42 to 90%for angiotens in converting enzyme inhibitors/angiotensin receptor blockers, and 14 to 70%fo r diuretics. Although data were not collected on baseline lifestyle instruction rates, instruction in the programs four lifestyle interventions was achieved b y discharge in 100%of the intervention cohort. Conclusion: Implementation of th is single center, systems based, inhospital program to initiate secondary stro ke prevention therapies was associated with a substantial increase in treatment utilization at the time of hospital discharge.展开更多
Background and Purpose -The Stroke PROTECT (Preventing Recurrence Of Thromb oembolic Events through Coordinated Treatment) program systematically implements , at the time of acute transient ischemic attack (TIA) or is...Background and Purpose -The Stroke PROTECT (Preventing Recurrence Of Thromb oembolic Events through Coordinated Treatment) program systematically implements , at the time of acute transient ischemic attack (TIA) or ischemic stroke admiss ion, 8 medication/behavioral secondary prevention measures known to improve outc ome in patients with cerebrovascular disease. The objective of this study was to determine if the high utilization rates previously demonstrated at hospital dis charge were maintained at 90 days after discharge. Methods -Data were prospect ively collected on consecutively encountered ischemic stroke and TIA patients ad mitted to a university hospital stroke service beginning September 1, 2002. PROT ECT interventions were initiated before hospital discharge in all PROTECT-targ et (underlying stroke mechanism large vessel atherosclerosis or small vessel dis ease) and PROTECT-ACS (At-risk for Coronary Sequelae) patients. Adherence to program goals was assessed 3 months after discharge. Results -During the peri od from September 2002 to August 2003, 144 individuals met criteria for PROTECT intervention. Of the 130 patients (90% ) with available day 90 follow-up data , mean age was 72 (range, 37 to 95), and 63% were male. Adherence rates in pat ients without specific contraindications were 100% for antithrombotics, 99% for statins, 92% for angiotensin-converting enzyme inhibitors/angiotensin re ceptor blockers, and 80% for thiazides. Awareness of the importance of calling 911 in response to stroke was 87% . Adherence to diet and exercise guidelines were 78% and 70% , respectively. Of the 24 smokers, tobacco cessation was mai ntained in 20 (83% ). Conclusions -High rates of adherence to PROTECT therapi es were maintained at 90 days after hospital discharge.展开更多
Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predi...Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data. Results: Of 2,894 subjects in the analysis dataset, 38%were women; 71%were recruited in the United States and 29%in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level ≥130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42%had an LDL ≤100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease. Conclusions: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.展开更多
文摘Background: The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual’s risk of atherosclerotic vascular disease. The authors evaluated the prevalence and prognosis of the MetS among individuals with symptomatic intracranial arterial stenosis. Methods: Patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease trial were evaluated in this post-hoc analysis. Baseline characteristics and outcome were compared in patients with the MetS vs patients without the MetS. Results: Among 476 patients, the prevalence of the MetS was 43%. MetS patients were more likely to be younger, female, and white. During a mean follow-up period of 1.8 years, time to the first of ischemic stroke, myocardial infarction, or vascular death was shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.6 (95%CI = 1.1 to 2.4, p = 0.0097). Time to ischemic stroke alone was also shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.7 (95%CI = 1.1 to 2.6, p = 0.012). When controlling for individual factors of the definition, MetS was not significant (combined outcome: p = 0.14; ischemic stroke: p = 0.074). Conclusions: The metabolic syndrome is present in about half of individuals with symptomatic intracranial atherosclerotic disease and is associated with a substantially higher risk of major vascular events. The metabolic syndrome may not provide additional ability to predict outcomes beyond the individual factors for patients with intracranial stenosis.
文摘Smokers with acute myocardial infarction have better outcomes after thrombolysis than nonsmokers. The authors evaluated the independent effect of smoking on short-term outcome following IV thrombolysis for acute ischemic stroke. After adjusting for covariates, recent smokers who received thrombolysis had a significantly greater drop in 24-hour median stroke severity scores from baseline than nonsmokers who received thrombolysis and lower mortality over 1 year.
文摘Objective: To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its ei ght secondary prevention goals at the time of discharge. Methods: Achievement ra tes for the eight program goals at time of discharge were compared in all patien ts discharged from a university hospitalbased stroke service with a diagnosis of ischemic st roke or TIA during a 1 year period after implementation of the PROTECT Program vs rates obtained from a comparable group of patients admitted to the same servi ce during the preceding year. Results: Demographic and medical features were com parable in the baseline and intervention cohorts for all patients with cerebral ischemia presumed due to large vessel atherosclerosis or small vessel disease (baseline year n = 117, intervention n = 130). Implementation rates in patients without specific contraindications increased for all four medication goals: 97 t o 100%for antithrombotic agents, 68 to 97%for statins, 42 to 90%for angiotens in converting enzyme inhibitors/angiotensin receptor blockers, and 14 to 70%fo r diuretics. Although data were not collected on baseline lifestyle instruction rates, instruction in the programs four lifestyle interventions was achieved b y discharge in 100%of the intervention cohort. Conclusion: Implementation of th is single center, systems based, inhospital program to initiate secondary stro ke prevention therapies was associated with a substantial increase in treatment utilization at the time of hospital discharge.
文摘Background and Purpose -The Stroke PROTECT (Preventing Recurrence Of Thromb oembolic Events through Coordinated Treatment) program systematically implements , at the time of acute transient ischemic attack (TIA) or ischemic stroke admiss ion, 8 medication/behavioral secondary prevention measures known to improve outc ome in patients with cerebrovascular disease. The objective of this study was to determine if the high utilization rates previously demonstrated at hospital dis charge were maintained at 90 days after discharge. Methods -Data were prospect ively collected on consecutively encountered ischemic stroke and TIA patients ad mitted to a university hospital stroke service beginning September 1, 2002. PROT ECT interventions were initiated before hospital discharge in all PROTECT-targ et (underlying stroke mechanism large vessel atherosclerosis or small vessel dis ease) and PROTECT-ACS (At-risk for Coronary Sequelae) patients. Adherence to program goals was assessed 3 months after discharge. Results -During the peri od from September 2002 to August 2003, 144 individuals met criteria for PROTECT intervention. Of the 130 patients (90% ) with available day 90 follow-up data , mean age was 72 (range, 37 to 95), and 63% were male. Adherence rates in pat ients without specific contraindications were 100% for antithrombotics, 99% for statins, 92% for angiotensin-converting enzyme inhibitors/angiotensin re ceptor blockers, and 80% for thiazides. Awareness of the importance of calling 911 in response to stroke was 87% . Adherence to diet and exercise guidelines were 78% and 70% , respectively. Of the 24 smokers, tobacco cessation was mai ntained in 20 (83% ). Conclusions -High rates of adherence to PROTECT therapi es were maintained at 90 days after hospital discharge.
文摘Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data. Results: Of 2,894 subjects in the analysis dataset, 38%were women; 71%were recruited in the United States and 29%in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level ≥130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42%had an LDL ≤100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease. Conclusions: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.
