Background: 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), the most frequently used lipid-lowering agents (LLAs) have neuroprotective effects in rodent models of ischemic stroke. The authors hyp...Background: 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), the most frequently used lipid-lowering agents (LLAs) have neuroprotective effects in rodent models of ischemic stroke. The authors hypothesized that patients with ischemic stroke taking LLAs would have better outcomes than patients not taking LLAs. Methods: The Northern Manhattan Study is a population-based study designed to determine stroke incidence and prognosis in a multiethnic, urban population. Northern Manhattan residents age 40 years or older diagnosed with their first ischemic stroke were eligible. Patients or their proxies were interviewed regarding medications being taken at home before stroke onset. The NIH Stroke Scale was used to assess stroke severity, categorized as mild (≤5), moderate (6 to 13), or severe (≥14), and the Barthel Index at 6 months to assess functional outcome. Clinical worsening in hospital was recorded by trial neurologists. Odds ratios and 95%CIs for association of LLA use and stroke severity, mortality, and functional outcome were calculated using logistic regression. Results: Of 650 patients, 57 (8.8%) were taking LLAs. The majority (90.9%) of LLA users were taking a statin. Clinical worsening in hospital occurred less frequently among patients taking LLAs at stroke onset (6.3%vs 18.2%; p=0.04). Ninety day mortality was lower in those taking LLAs (1.8%vs 10.6%, p=0.03). The proportion of patients with severe stroke among those taking LLAs was not lower (10.7%vs 16.8%, p=0.39). Conclusion: Patients taking lipid-lowering agents (LLAs) at the time of an ischemic stroke may have lower poststroke mortality and a lower risk of worsening during hospitalization. Prospective studies are warranted to determine whether LLAs, and statins in particular, have neuroprotective properties or other beneficial effects in acute ischemic stroke.展开更多
Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte...Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte count in a stroke- free population predict future ischemic stroke (IS). Methods: A populationbased prospective cohort study was performed in a multiethnic urban population. Stroke - free community participants were identified by random- digit dialing. Leukoc yte levels were measured at enrollment, and participants were followed annually for IS, myocardial infarction (MI), and cause- specific mortality. Cox proporti onal hazards regression models were used to calculate hazard ratios (HRs) and 95 % CIs for IS, MI, and vascular death after adjustment for medical, behavioral, and socioeconomic factors. Results: Among 3,103 stroke- free community partici pants (mean age 69.2 ± 10.3 years) with baseline leukocyte levels measured, med ian follow- up was 5.2 years. After adjusting for stroke risk factors, each SD in leukocyte count (1.8 × 109 cells/L) was associated with an increased risk of IS (HR 1.22, 95% CI 1.05 to 1.42), and IS, MI, or vascular death (HR 1.13, 95 % CI 1.02 to 1.26). Compared with those in the lowest quartile of leukocyte co unt, those in the highest had an increased risk of IS (adjusted HR 1.75, 95% C I 1.08 to 2.82). The effect on atherosclerotic and cardioembolic stroke was grea ter than in other stroke subtypes. Conclusion: Relative elevations in leukocyte count are independently associated with an increased risk of future ischemic str oke and other cardiovascular events.展开更多
Background and Purpose -We evaluated the association between electrocardiographic left atrial abnormality (ECG-LAA) and ischemic stroke, especially whether ECG-LAA provides additional prognostic information to that pr...Background and Purpose -We evaluated the association between electrocardiographic left atrial abnormality (ECG-LAA) and ischemic stroke, especially whether ECG-LAA provides additional prognostic information to that provided by echocardiography. Methods -A population-based, case-control study included 146 patients with first ischemic stroke and 195 age-, gender-, and race/ethnicity-matched community control subjects. ECG-LAA was defined as either P-wave duration > 120 ms or P-terminal force in precordial lead V1 (PTFV1)>40 ms·mm. Results - TFV1 >40 ms·mm was associated with ischemic stroke after adjustment for other stroke risk factors (odds ratio [OR], 2.32; 95%CI, 1.29 to 4.18). The association remained significant after adding echocardiographic left atrial diameter to the model (OR, 2.31; 95%CI, 1.28 to 4.17). PTFV1 was independently associated with stroke in patients in the upper half of echocardiographically determined left ventricular mass (adjusted OR, 4.5; 95%CI, 2.20 to 9.15) but not in those in the lower half (OR, 0.58; 95%CI, 0.20 to 1.65; P=0.0008). Conclusions-ECG-LAA can supplement 2D echocardiography in assessing the risk of ischemic stroke, especially in subjects with increased left ventricular mass.展开更多
文摘Background: 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), the most frequently used lipid-lowering agents (LLAs) have neuroprotective effects in rodent models of ischemic stroke. The authors hypothesized that patients with ischemic stroke taking LLAs would have better outcomes than patients not taking LLAs. Methods: The Northern Manhattan Study is a population-based study designed to determine stroke incidence and prognosis in a multiethnic, urban population. Northern Manhattan residents age 40 years or older diagnosed with their first ischemic stroke were eligible. Patients or their proxies were interviewed regarding medications being taken at home before stroke onset. The NIH Stroke Scale was used to assess stroke severity, categorized as mild (≤5), moderate (6 to 13), or severe (≥14), and the Barthel Index at 6 months to assess functional outcome. Clinical worsening in hospital was recorded by trial neurologists. Odds ratios and 95%CIs for association of LLA use and stroke severity, mortality, and functional outcome were calculated using logistic regression. Results: Of 650 patients, 57 (8.8%) were taking LLAs. The majority (90.9%) of LLA users were taking a statin. Clinical worsening in hospital occurred less frequently among patients taking LLAs at stroke onset (6.3%vs 18.2%; p=0.04). Ninety day mortality was lower in those taking LLAs (1.8%vs 10.6%, p=0.03). The proportion of patients with severe stroke among those taking LLAs was not lower (10.7%vs 16.8%, p=0.39). Conclusion: Patients taking lipid-lowering agents (LLAs) at the time of an ischemic stroke may have lower poststroke mortality and a lower risk of worsening during hospitalization. Prospective studies are warranted to determine whether LLAs, and statins in particular, have neuroprotective properties or other beneficial effects in acute ischemic stroke.
文摘Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease. Objective: To inves tigate the hypothesis that relative elevations in leukocyte count in a stroke- free population predict future ischemic stroke (IS). Methods: A populationbased prospective cohort study was performed in a multiethnic urban population. Stroke - free community participants were identified by random- digit dialing. Leukoc yte levels were measured at enrollment, and participants were followed annually for IS, myocardial infarction (MI), and cause- specific mortality. Cox proporti onal hazards regression models were used to calculate hazard ratios (HRs) and 95 % CIs for IS, MI, and vascular death after adjustment for medical, behavioral, and socioeconomic factors. Results: Among 3,103 stroke- free community partici pants (mean age 69.2 ± 10.3 years) with baseline leukocyte levels measured, med ian follow- up was 5.2 years. After adjusting for stroke risk factors, each SD in leukocyte count (1.8 × 109 cells/L) was associated with an increased risk of IS (HR 1.22, 95% CI 1.05 to 1.42), and IS, MI, or vascular death (HR 1.13, 95 % CI 1.02 to 1.26). Compared with those in the lowest quartile of leukocyte co unt, those in the highest had an increased risk of IS (adjusted HR 1.75, 95% C I 1.08 to 2.82). The effect on atherosclerotic and cardioembolic stroke was grea ter than in other stroke subtypes. Conclusion: Relative elevations in leukocyte count are independently associated with an increased risk of future ischemic str oke and other cardiovascular events.
文摘Background and Purpose -We evaluated the association between electrocardiographic left atrial abnormality (ECG-LAA) and ischemic stroke, especially whether ECG-LAA provides additional prognostic information to that provided by echocardiography. Methods -A population-based, case-control study included 146 patients with first ischemic stroke and 195 age-, gender-, and race/ethnicity-matched community control subjects. ECG-LAA was defined as either P-wave duration > 120 ms or P-terminal force in precordial lead V1 (PTFV1)>40 ms·mm. Results - TFV1 >40 ms·mm was associated with ischemic stroke after adjustment for other stroke risk factors (odds ratio [OR], 2.32; 95%CI, 1.29 to 4.18). The association remained significant after adding echocardiographic left atrial diameter to the model (OR, 2.31; 95%CI, 1.28 to 4.17). PTFV1 was independently associated with stroke in patients in the upper half of echocardiographically determined left ventricular mass (adjusted OR, 4.5; 95%CI, 2.20 to 9.15) but not in those in the lower half (OR, 0.58; 95%CI, 0.20 to 1.65; P=0.0008). Conclusions-ECG-LAA can supplement 2D echocardiography in assessing the risk of ischemic stroke, especially in subjects with increased left ventricular mass.
