Search

Abstract: Background: Asymmetric dimethylarginine (ADMA) has recently been investigated as a risk marker for cardio- and cerebrovascular diseases. However, whether ADMA levels are related to the risk of stroke in the Japanese general population remains unclear. Methods: We examined 769 Japanese men (mean age, 47±5years) undergoing health examinations. Each subject's ADMA level and various vascular risk factors were assessed; the predicted 10-year stroke risk was calculated using the point-based prediction model from the Japan Public Health Center Study. Results: In a multiple linear regression analysis, age, body mass index, estimated glomerular filtration rate, and current smoking status were significant independent determinants of ADMA levels. A significant odds ratio (OR) for high predicted stroke risk (10-year risk≥5%)was noted in the highest quartile of ADMA levels (OR, 2.47; 95% CI, 1.002–6.07), compared with the lowest quartile, after adjusting for potential confounding factors. A significant OR for high predicted stroke risk was also found for each standard deviation increment in ADMA level (adjusted OR, 1.46; 95% CI, 1.10–1.92). Conclusion: Elevated ADMA levels were significantly associated with an increased predicted stroke risk, suggesting that measuring ADMA levels may be useful for identifying middle-aged Japanese men with a high risk of stroke. [Copyright &y& Elsevier]

Abstract: Background: The aims of this study were to clarify the risk factors for stroke, and to investigate the effect of low-density lipoprotein cholesterol (LDL-C) lowering with pravastatin on the risk of stroke, in Japanese mild-to-moderately hypercholesterolemic patients enrolled in the MEGA Study. Methods: Multivariate Cox proportional hazard model was used to determine the baseline risk factors for stroke. The proportion of treatment effect (PTE) explained by on-treatment LDL-C levels was estimated. Results: In 7832 patients at risk, a total of 99 strokes were observed during the 5-year follow-up period. Significant relationships were observed between stroke and traditional risk factors such as male sex, advanced age, low high-density lipoprotein cholesterol (HDL-C), high lipoprotein(a) (Lp[a]), hypertension, diabetes, obesity, and smoking. In the pravastatin group, hazard ratio (HR) for stroke adjusted by on-treatment lipid level was lower than the unadjusted value versus control (HR [95%CI], 0.48 [0.26–0.87] and 0.59 [0.38–0.92], respectively)—giving a negative PTE of −38.6% and suggesting that the risk reduction could not be explained by LDL-C lowering alone. Conclusions: Male sex, aging, hypertension, diabetes, low HDL-C, high Lp(a), obesity, and smoking were determined as risk factors for stroke in Japanese patients with hypercholesterolemia, and the observed risk reduction could not be explained by pravastatin''s LDL-C-lowering effect alone, suggesting pleiotropic effects. [Copyright &y& Elsevier]

Abstract: Background: Vascular localization of symptomatic large artery atherosclerotic (LAA) stroke differs for unknown reasons by race-ethnicity. The metabolic syndrome (MetSD) is associated with higher atherosclerotic stroke risk and comprises abnormal risk factors that can vary by race. Thus, we investigated whether MetSD may contribute to race-ethnic differences in LAA stroke by examining the association of MetSD with symptomatic intra- and extracranial atherosclerosis among a diverse race-ethnic group. Method: We analyzed data prospectively collected over a 4-year period on subjects with ischemic stroke/TIA. Independent vascular risk factor associations with intracranial and extracranial LAA vs. non-LAA mechanism were evaluated in two groups stratified by race-ethnicity; whites and non-whites (Hispanics, African-American, and Asian-American). Results: 1167 patients met study criteria. Intracranial LAA was more prevalent in non-whites vs. whites (20.4% vs. 9.6%, P <0.001), while extracranial LAA had a more frequent point value in whites compared to non-whites (10.7% vs. 7.5%, P =0.267). The presence of MetSD was more prevalent in both intracranial and extracranial LAA group than in non-LAA group: no significant differences were observed in the prevalence of MetSD between intra vs. extracranial LAA or whites vs. non-whites. However, with increasing numbers of abnormal metabolic components, whites were more likely to have experienced extracranial LAA, whereas non-whites were more likely to have experienced intracranial LAA. After adjusting for covariates, MetSD was associated with extracranial LAA in whites (OR, 1.98; 95% CI, 1.13–3.45), while there was a tendency that intracranial LAA was associated with MetSD in non-whites (OR, 1.80; 95% CI, 0.97–3.32). No association was found between MetSD and extracranial LAA in non-whites and between this syndrome with intracranial LAA in whites. Conclusions: Our results showed that the impact of MetSD on the distribution of cervicocephalic atherosclerosis differed by race-ethnicity. This finding may in part explain the well-known differences in race-ethnic predilection to intracranial or extracranial atherosclerosis. [Copyright &y& Elsevier]

Abstract: Background: There are conflicting data on the relationship between peripheral arterial disease (PAD) as defined by an ankle–brachial index (ABI) of <0.9 and stroke risk, and these prior data have largely focused on a single race or gender. Furthermore, the association between subsequent ABIs above the established 0.9 threshold for PAD vs. stroke has not been studied. This study assessed stroke occurrence across the full spectrum of ABI values among a broad cohort of stroke survivors. Methods: Data from the National Health and Nutrition Examination Survey from 1999–2004, a nationally representative sample of United States adults, were used to assess prevalence of PAD as evidenced by ABI of <0.9, and to simultaneously identify the independent associations of ABI levels (<0.90, 0.90–0.99, 1.00–1.09, >1.3) with stroke prevalence. Results: Among 6382 adults, 4602 (72%) had full and complete data of which 277 (6%) reported stroke occurrence. Stroke survivors were older and more likely to have diabetes, hypertension, coronary artery disease, elevated blood pressure and glycohemoglobin, than non-stroke respondents. More subjects with ABI <0.9 vs. ≥0.9 had experienced a stroke (12.7% vs. 5.4%, p<0.001). Within the full ABI range, stroke presence rose with decreasing ABI (p =0.0013). After adjustment for potential confounders, only ABI <0.9 (OR 1.9, 95% CI=1.2–3.1) and 0.9–0.99 (OR 2.3, 95% CI=1.4–3.6) compared with the referent group (1.10–1.29) were significantly associated with presence of stroke. Conclusions: Data from this nationally representative cohort support an independent relationship between established PAD and stroke occurrence, but also indicate that even borderline PAD is strongly linked to stroke. [Copyright &y& Elsevier]

Abstract: Background and purpose: Stroke risk of asymptomatic atherosclerotic middle cerebral artery (MCA) stenosis has not been well studied. This study was designed to investigate stroke risk and prognostic factors of asymptomatic atherosclerotic MCA stenosis. Materials and methods: A total of 200 consecutive patients who visited the transcranial Doppler ultrasound (TCD) laboratory of our hospital and who met the following criteria were prospectively enrolled in this study: diagnosed as MCA stenosis due to atherosclerosis by TCD, age above 40years old, no history of ischemic stroke or transient ischemic attack (TIA), no ipsilateral carotid artery stenosis. The mean follow-up time was 38.3±9.9 (range 4 to 60) months. Results: Thirteen patients were lost to follow up. Seven patients (3.8%) developed ischemic stroke or TIA during the follow-up period, with an occurrence rate of 0.5% in the first year and 1.6% in the second year. Three were in the blood supply region of diseased vessels, three were in the contralateral hemisphere and one case of TIA occurred in the posterior circulation. Univariate analysis showed that diabetes mellitus (DM) (X2 =9.168, p=0.002) and carotid atherosclerotic plaque (X2 =4.403, p=0.036) were associated with higher risk of stroke occurrence in this cohort. Conclusions: The stroke risk in patients with asymptomatic atherosclerotic MCA stenosis was low and remained stable during follow up. Higher risk of stroke occurrence is associated with DM and carotid atherosclerotic plaque. [ABSTRACT FROM AUTHOR]