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Cerebrovascular events are linked to ankylosing spondylitis. Accelerated atherosclerosis and endothelial dysfunction against a backdrop of inflammation have been widely blamed for the increased cerebrovascular risk in ankylosing spondylitis. The absence of a comprehensive review encouraged us to consider the link between ankylosing spondylitis and cerebrovascular diseases. Web of Science, PubMed, Medline, Scopus, and EMBASE were searched to identify studies published from 2000 to June 10, 2023. All observational and cohort studies reporting myocardial infarction or stroke and considering classic cerebrovascular risk in ankylosing spondylitis patients and healthy controls were included. Most of the included studies reported that the risk of cerebrovascular disorders was greater in ankylosing spondylitis than in the general population. Also, most studies showed that for both sexes, the prevalence of cardiovascular illnesses rose with age, and this trend was consistent across all subgroups of cardiovascular disorders. Also, most studies reported that the rate of cerebrovascular accidents in ankylosing spondylitis patients was higher than in control groups. Some studies reported that the risk of developing an ischemic stroke was higher in young patients with ankylosing spondylitis, while others did not. Our systematic analysis found that most studies agreed that ankylosing spondylitis patients had a higher risk of cerebrovascular diseases than the general population. Still, this increased risk was influenced by several factors that need further research exploration. [ABSTRACT FROM AUTHOR]

Simple Summary: Previous studies have shown that the occurrence of cerebrovascular-specific diseases was common in cancer patients. However, the association between colorectal cancer and cerebrovascular-specific diseases remains to be fully elucidated. In this large-population cohort study, we found that the mortality of cerebrovascular-specific diseases mortality in colorectal cancer patients was significantly higher than the general US population. In addition, we investigated several potential predictors of cerebrovascular-specific diseases mortality in colorectal cancer. This study may be useful for the prevention, risk stratification and therapeutic optimization of cerebrovascular-specific diseases in colorectal cancer patients. Background: Colorectal cancer (CRC) is one of the most prevalent diseases and the second leading cause of death worldwide. However, the relationship between CRC and cerebrovascular-specific mortality (CVSM) remains elusive, and less is known about the influencing factors associated with CVSM in CRC. Here, we aimed to analyze the incidence as well as the risk factors of CVSM in CRC. Methods: Patients with a primary CRC diagnosed between 1973 and 2015 were identified from the Surveillance Epidemiology and End Results database, with follow-up data available until 31 December 2016. Conditional standardized mortality ratios were calculated to compare the incidence of CVSM between CRC patients and the general U.S. population. Univariate and multivariate survival analyses with a competing risk model were used to interrogate the risk factors for CVSM. Results: A total of 563,298 CRC individuals were included. The CVSM in CRC patients was significantly higher than the general population in all age subgroups. Among the competing causes of death in patients, the cumulative mortality caused by cerebrovascular-specific diseases steadily increased during the study period. While age, surgery, other/unknown race and tumors located at the transverse colon positively influenced CVSM on both univariate and multivariate analyses, male patients and those who had radiotherapy, chemotherapy, a more recent year (2001–2015) of diagnosis, a grade II or III CRC, rectal cancer, or multiple primary or distant tumors experienced a lower risk of CVSM. Interpretation: Our data suggest a potential role for CRC in the incidence of CVSM and also identify several significant predictors of CVSM that may be helpful for risk stratification and the therapeutic optimization of cerebrovascular-specific diseases in CRC patients. [ABSTRACT FROM AUTHOR]

The aim of the present study was to perform a meta-analysis of published data to determine the significance of clinical factors and exposures to the risk of perinatal arterial ischaemic stroke ( PAIS) and provide guidance for clinical diagnosis and treatment. A comprehensive literature search of the PubMed, Embase, MEDLINE and Cochrane Library databases for relevant observational studies (cohort/case−control) from March 1984 to March 2016 was undertaken. Two review authors independently examined the full text records to determine which studies met the inclusion criteria and evaluated risk factors for PAIS. Risk ratios, odds ratios and 95% confidence intervals were estimated. A total of 11 studies were included in the analyses. Intrapartum fever >38°C, pre-eclampsia, oligohydramnios, primiparity, forceps delivery, vacuum delivery, fetal heart rate abnormalities, abnormal cardiotocography tracing, cord abnormalities, birth asphyxia, emergency caesarean section, tight nuchal cord, meconium-stained amniotic fluid, umbilical arterial pH <7.10, Apgar score at 5 min <7, resuscitation at birth, hypoglycaemia, male gender and small for gestational age were identified as risk factors for PAIS. This systemic review and meta-analysis provides a preliminary evidence-based assessment of the risk factors for PAIS. Patients with any of the risk factors identified in this analysis should be given careful consideration to ensure the prevention of PAIS. Future studies focusing on the combined effects of multiple prenatal, perinatal and neonatal risk factors for PAIS are warranted. [ABSTRACT FROM AUTHOR]

Background: To investigate prevalence and risk factors for post stroke pneumonia (PSP) in patients with acute ischemic stroke treated at stroke units (SU).Method: We analysed data from the Austrian Stroke Unit registry concerning admissions from January 2003 to December 2013 and assessed the prevalence of PSP at the stroke unit. Patients with and without PSP were compared in univariate and multivariate models searching for factors associated with the occurrence of PSP at the SU.Results: Three thousand one hundred eleven patients (5.2%) of 59,558 analysed patients were diagnosed with PSP. While age and stroke severity were non-modifiable factors associated with PSP, modifiable risk factors included chronic alcohol consumption and atrial fibrillation. Patients who developed neurological, cardiac, and other infective complications showed a higher prevalence of PSP, an increased prevalence was also found in connection with the placement of nasogastric tubes or urinary catheters. Female sex, left hemispheric stroke, cryptogenic stroke pathogenesis and additionally, treatment with lipid lowering drugs were factors associated with a lower PSP prevalence.Conclusion: Pneumonia in acute ischemic stroke is associated with a variety of modifiable and unmodifiable factors that allow to identify patients at high risk of developing PSP and to focus on early preventive measures at the SU. Further studies could use the results of this study to explore potential benefits of specific interventions targeted at these factors. [ABSTRACT FROM AUTHOR]

Background-Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known. Methods and Results-Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models. Conclusions-These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors. [ABSTRACT FROM AUTHOR]

The article presents several case studies to illustrate adverse drug reactions (ADRs) reported by the U.S. Institute for Safe Medication Practices (ISMP). It discusses a case of toxic epidermal necrolysis that was induced as an ADR of the myocardial depressant Amiodarone and informs about another case in which a patient was diagnosed with cerebrovascular disease as an ADR of the drug Nilotinib. Also mentioned is a case acute liver failure caused by the drug Etodolac.

Background Major adverse cardiac and cerebrovascular events (MACCE) represent the most common cause of serious perioperative morbidity and mortality. Our aim was to identify risk factors for MACCE in a broad surgical population with intermediate-to-high surgery-specific risk and to build and validate a model to predict the risk of MACCE. Methods A prospective, multicentre study of patients undergoing surgical procedures under general or regional anaesthesia in 23 hospitals. The main outcome was the occurrence of at least one perioperative MACCE, defined as any of the following complications from admittance to discharge: cardiac death, cerebrovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, angina, or stroke. The MACCE predictive index was based on β-coefficients and validated in an external data set. Results Of 3387 patients recruited, 146 (4.3%) developed at least one MACCE. The regression model identified seven independent risk factors for MACCE: history of coronary artery disease, history of chronic congestive heart failure, chronic kidney disease, history of cerebrovascular disease, preoperative abnormal ECG, intraoperative hypotension, and blood transfusion. The area under the receiver-operating characteristic curve was 75.9% (95% confidence interval, 71.2–80.6%). Conclusions The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk. [ABSTRACT FROM AUTHOR]

Plasma protein S (PS) levels are reportedly low in patients with venous thrombosis but high in coronary heart disease (CHD) patients. The authors examined the association between free PS concentration and CHD or stroke risk and assessed risk in combination with C-reactive protein (CRP) levels. Free PS concentration was determined in 6 annual visits among 3,052 middle-aged (49–64 years) United Kingdom men from the Second Northwick Park Heart Study, with 297 CHD events from 1989 to 2005. The highest (vs. first) quintile was associated with a significantly increased CHD risk after adjustment for all other risk factors and correction for regression dilution bias (hazard ratio = 1.85, 95% confidence interval: 1.08, 3.16; P = 0.024). Models that included all well-known risk factors plus PS quintiles improved prediction of CHD (net reclassification improvement (NRI) = 7.0% (P = 0.007), category-less NRI (>0) = 22.1% (P < 0.001)), and the likelihood ratio statistic increased significantly (P = 0.018). The increase in CHD risk was particularly strong when subjects also had high CRP levels. There was no association between free PS level and stroke risk. This study confirms the independent association of elevated free PS levels with future risk of CHD, although elevated PS levels added only modestly to prediction metrics. The novel finding of increased CHD risk, particularly when CRP and PS levels are high, requires further study. [ABSTRACT FROM PUBLISHER]

Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureş (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries. Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke. Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age. Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Stroke is a serious complication to cardiac surgery, and is generally considered as a uniform disease regardless of its temporal relationship to surgery. Our hypothesis suggests that stroke, in association with surgery, reflects other characteristics than stroke occurring with a free interval. This issue was here explored for risk factors and survival effects. Methods: Data were collected from 7839 procedures of isolated coronary artery bypass grafting (CABG), 297 off-pump CABG, and 986 combined CABG and valve procedures. Records of patients with any signs of neurological complications were reviewed to extract 149 subjects with stroke at extubation (early, 1.6%) versus 99 patients having a free interval (delayed, 1.1%). Survival data were complete, with a median follow-up time of 9.3 years (maximum 16.3 years). Independent risk factors were analyzed by logistic regression and survival by Cox regression. Results: Risk factors for early stroke were advanced age, high preoperative creatinine level, extent of aortic atherosclerosis, and long cardiopulmonary bypass time (all P <0.001). Factors associated with delayed stroke were female gender (P <0.001), unstable angina (P =0.003), previous cerebrovascular disease (P =0.009), inotropic support requirement (P <0.001), and postoperative atrial fibrillation (P <0.001). Stroke explained mortality not only in the early postoperative period (P <0.001), but also at long-term follow-up (P <0.001). Early and delayed stroke were associated with mortality hazard ratios (HRs) of 1.44 and 1.85 (P =0.008, P <0.001), respectively. However, for patients surviving their first postoperative year, early stroke did not influence long-term mortality (HR 1.07, P =0.695). This was in contrast to delayed stroke (HR 1.71, P =0.001). Conclusions: Early and delayed stroke differed in their related risk factors. The influence of stroke on short-term mortality was obvious and devastating. Mortality in association with early stroke mainly presented itself in the acute period, whereas for delayed stroke survival continued to be impaired also in the long-term perspective. Our report emphasizes that early and delayed stroke should be considered as two separate entities. [Copyright &y& Elsevier]

Cerebrovascular insult (CVI) is one of leading causes of mortality and morbidity worldwide, with significant influence of lifestyle on its development. The aim of this study was to investigate the different risk factors and their impact on hyperlipidaemia in two ethnic groups of patients who were hospitalized after CVI during two years. The total of 230 patients, 35-65 years old, with the ischemic CVI who had been hospitalized and treated at the Clinical Center Priština were included in our study. The patients were divided into two groups: group A (n=130)- Muslim patients, and group S (n=100) - Orthodox patients. Their antropometric and serum lipid parameters were measured and nutritional habits were assessed by food frequency questionnaire (FFQ). The patients from both groups were classified as adipose, with BMI in males around 33, and in females 28-30. Percentage of body fat was also high in both groups, especially in women (p<0.001), without significant difference between groups A and S. Physical activity was very low in both studied groups. In the group A, 86.92% patients with CVI were physically inactive, while in the group S the percentage amounted to 92% (p<0.001). The number of smokers was rather high in both groups, particularly in group S (89%) and more than a half (53%) of examinees had been smoking for more than 10 years. Almost all smokers consumed more than 20 cigarettes per day (83%). In group A, there were 35% of non-smokers (p<0.001). The average diastolic blood pressure value in the groups A and S (Table 6,7) was 97.97±4.75 mmHg and 100.82±6.71 mmHg, respectively, while systolic pressure was 174.27±3.18 mmHg in group A and 183.73±11.39 mmHg in group S. In spite of different lifestyles in both groups, the studied risk factors were proved to have significant influence on the onset of hyperlipidemia. The S group patients whose diet was predominantly based on animal fats had significantly higher risk in comparison to the group whose diet was based on vegetable fats. Smoking habits and physical inactivity were widely present in both groups. Our results suggest the need for target nutrition messages and behavioral interventions in developing prevention strategies for reduction of cerebrovascular risk factors. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a single or multiple risk factors have a relative significance on the mortality and morbidity of stroke and whether previous treatment of major risk factors like hypertension and diabetes mellitus had any positive influence on the clinical outcome. Methodology: One thousand consecutive cases of acute stroke were included in this prospective descriptive study conducted at the Dept. of Neurology, Jinnah Postgraduate Medical Centre, Karachi from Dec. 1985 to July 1988. A special proforma was designed to collect all the relevant clinical information. Functional status was assessed by using the Barthel Index activity score. Scores obtained at admission were compared with the scores obtained at six weeks follow-up. The results were then analyzed in the background of various risk factors present. Similar observations were made in assessing the mortality. The pre-stroke treatment status of major risk factors like hypertension and diabetes mellitus was also studied. Results: Of the 1000 cases, 61% were male and 39% female. Majority of the cases were in the age group 60-69 years. Hypertension (HTN) alone was present in 58.3% followed by diabetes mellitus (DM) 5%, ischemic heart disease (IHD) 1.3%, whereas in 19.8% HTN, DM, IHD were present in various combinations, 1.5% had Valvular Heart Disease (VHD) while 14.1% had none of the above risk factors. Six-weeks follow-up was available on (673/1000) 67% cases. Gross mortality was 59% (396/673). Higher mortality was seen in cases with Glasgow Coma Scale (GCS) range 3-9/15. Risk factor profile in fatal cases showed that 221/379 (58%) had HTN, 21/32 (65%) had DM, 6/12 (50%) had IHD and 6/10 (60%) had Valvular heart disease (VHD). Some patients had multiple risk factors, among those 60/95 (63%) had HTN + DM, 19/41 (46%) had HTN + IHD, 5/7 (71%) had DM+ IHD, 11/16 (68%) had HTN + DM + IHD while 47/81 (58%) had none of the above risk factors. Relative influence of individual risk factor or in combination was not statistically significant. The functional recovery showed no significant relative difference among patients with different risk factors. There was no significant difference in the outcome among treated and untreated hypertensive and diabetic patients. Conclusions: Individual or multiple risk factors do not have a relative influence on the higher morbidity and mortality in stroke. For poor prognosis severity of stoke at onset is more important than the type of risk factors. Furthermore, there was no difference in outcome in patients who got pre-stroke treatment compared to those who had no treatment. [ABSTRACT FROM AUTHOR]

Background: The clinical spectrum of the cerebral vein and dural sinus thrombosis (CVT) is wide and nonspecific. With the development of neuroimaging techniques, their identification recently improved. Objectives: To collect data, identify causes and risk factors, to evaluate treatment and outcome Patients and methods: 67 patients were admitted between 1998-2008. Their demographic, clinical, radiological data were analysed. The diagnosis was based on MRI+MRA, and/or CT+DSA. Received treatments and outcomes (mRS) were recorded at admission, after 1st and 3rd month, respectively. Results: Sex distribution was: 35 women, 32 men; their average age was 41.92 years; 24 out of 35 women were fertile. The major clinical manifestations included headache, in 40 patients, focal neurological deficit in 8 patients, papilledema in 10 patients. All patients underwent CT, MRI+MRA in 41 patients, DSA in 4 patients. The most frequent thrombosed sinus was superior saggital sinus (30 patients). Risk factors were identified for 32 patients. After 90 days after admission, death rate was 5.97% (4 patients), and 73.84% made a recovery between 0-2 mRS. Conclusion: CVT were underdiagnosed in our region (low percentage of admissions for benign intracranial hypertension). Even though the percentage of women of fertile age was great, oral contraceptives were not an important risk factor. Diagnostic methods and emergency management were not yet standardized enough, while anticoagulants were systematically used. [ABSTRACT FROM AUTHOR]

Few studies have determined whether carotid artery intima-media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6–9 years' follow-up (1987–1995) among 7,865 women and 6,349 men aged 45–64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (≥1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence. Am J Epidemiol 2000;151:478–87. [ABSTRACT FROM PUBLISHER]

Stroke is the third leading cause of death in US Blacks and is an important cause of mortality and morbidity worldwide. Mortality rates are higher in Blacks than in Whites in the United States at ages below 70 years. In Blacks, advanced age, elevated blood pressure, diabetes mellitus, and smoking are the only risk factors for stroke whose status has been firmly established by published data. More data are needed to assess other likely risk factors of importance for risk stratification and intervention and to determine the fraction of racial differences in stroke that may be explained by risk factor differences. Higher prevalences of hypertension, diabetes, obesity (in women), elevated lipoprotein(a) level, smoking (in men), and low socioeconomic status may contribute to the higher stroke incidence and mortality in US Blacks as compared with Whites. However, further environmental influences must be studied and candidate genes identified before assuming that racial differences can be attributed to inborn susceptibility linked to inheritance of specific genes. Am J Epidemiol 1999; 150: 1266-74. [ABSTRACT FROM PUBLISHER]

Introduction: Identification of stroke risk factors is of great importance to prevent the disease and its sequels. Objective: Is to analyze the known stroke risk factors and to study the education level, housing condition and economic status as possible relevant stroke risk factors. Patients and methods: 510 patients with ischemic stroke of different types and severity who were admitted to 3 hospitals in Baghdad. The patients were examined and investigated thoroughly. Special emphasis was concentrated on education level, housing condition and economic status. Results: 510 patients were studied, 215 females and 295 males. The study showed 16 % higher male prevalence. Hypertension is commonest risk factor in the present study (75.5%) followed by other risk factors. the study showed a higher number of stroke patients [44.7%] was illiterate, in comparison to [9%] of the patients with the higher education. The study showed more prevalence of the stroke patients [90.39%] live in crowded small houses. The study showed [36%] of stroke patients belongs to families with below 100 USD monthly incomes. Discussion: Higher prevalence of diabetes mellitus, hypertension, smoking and also poor health awareness in patients with low educational levels, poor economic state and poor housing condition. Conclusion: Stroke is increased in low educational levels, poor economic state and poor housing condition. . There is a high percentage of hypertension not previously diagnosed despite stigmata of chronic hypertension. [ABSTRACT FROM AUTHOR]

Objective: Stroke is a major complication after coronary surgery, occurring in 1–4% of the patients. In this study, we evaluate the incidence and pre- and intraoperative risk factors for the development of a cerebrovascular accident (CVA) and the impact of such an event on perioperative mortality and on hospital length of stay. Methods: Data from 4567 patients submitted to isolated coronary artery bypass grafting (CABG) with hypothermic ventricular fibrillation between 1992 and 2001 were entered prospectively into a dedicated computerized database and analyzed retrospectively at this time. Univariate and multivariate analyses were performed where appropriate. Results: The incidence of postoperative CVA was 2.5% (116 patients). Multivariable logistic regression identified the following variables to be independent predictors of a postoperative CVA: cerebrovascular disease (P<0.001; odds ratio (OR), 2.66), peripheral vascular disease (P<0.001; OR, 2.33), number of periods of aortic cross-clamping (P=0.019; OR, 1.31 per each period of aortic cross-clamping), LV dysfunction (P=0.012; OR, 1.82) and age (P=0.008; OR, 1.28 per each 10 years). Non-elective surgery showed a marginal significance (P=0.08; OR 1.83). The 30-day mortality for patients who experienced a CVA was 16.4% versus 0.6% for patients who did not (P<0.001). Postoperative CVA increased the length of hospital stay threefold to 20.3±28.3 days as compared with patients who did not have a postoperative CVA (7.6±4.2 days; P<0.001). Conclusions: Postoperative CVA dramatically increases the mortality and length of stay after CABG. Identification of predisposing factors permits preoperative risk stratification and may facilitate improved patient selection or optimization. Our study adds evidence to the superiority of the fibrillation technique over intermittent cross-clamping of the aorta, among non-cardioplegic techniques, in terms of neurological protection. [Copyright &y& Elsevier]

Abstract. Rosmond R, Björntorp P (University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden). The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000; 247: 188–197. Objectives. The hypothalamic–pituitary–adrenal (HPA) axis, the mediator of cortisol, plays a central role in the homeostatic processes. In this study, we addressed the potential impact of HPA axis activity on established anthropometric, metabolic and haemodynamic risk factors for cardiovascular disease (CVD), type 2 diabetes mellitus and stroke. Design. A cross-sectional study. Subjects. A subgroup of 284 men from a population sample of 1040 at the age of 51 years. Main outcome measures. Anthropometric measurements included body mass index (BMI, kg m–2), waist/hip circumference ratio (WHR) and abdominal sagittal diameter (D). Overnight fasting values of blood glucose, serum insulin, triglycerides, total, low (LDL) and high density (HDL) lipoprotein cholesterol, as well as resting heart rate and blood pressure, were also determined. By using repeated diurnal salivary cortisol measurements during everyday conditions, methods were developed to characterize the status of the HPA axis, and set in relation to the anthropometric, metabolic and haemodynamic measurements. Results. In bivariate analyses, risk factors intercorrelated in clusters of anthropometric (BMI, WHR, D), metabolic (insulin, glucose and their ratio, triglycerides, cholesterol [total and LDL], HDL cholesterol [negative]) and haemodynamic (systolic and diastolic blood pressure and heart rate) measurements. This was also the case in the two-dimensional scaling analysis, where, however, HDL separated out. A normal HPA axis status, characterized by high variability and morning cortisol values, as well as a clear response to a standardized lunch and dexamethasone suppression test, was then introduced by a statistical weighting procedure. This did not essentially change the results of either the bivariate correlation matrix or the two-dimensional scaling analysis. A similar introduction of a pathological HPA axis, characterized by low variability and morning cortisol values, a poor lunch-induced cortisol response and a blunted dexamethasone suppression of cortisol, changed the results markedly. Now strong and consistent correlations were found not only within but also between different clusters of risk factors, which also congregated into one distinct cluster, again except for HDL cholesterol. Conclusions. These results disclose the prospect of an overriding function of a pathological HPA axis on other, established risk factors for CVD, type 2 diabetes and stroke. Its close association to HPA axis dysfunction may explain the previously reported powerful risk indication of abdominal obesity for the diseases mentioned. The HPA axis abnormality has been reported to be a characteristic consequence of frequently repeated or chronic environmental stress challenges. [ABSTRACT FROM AUTHOR]

Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke, but the absolute rate of stroke varies widely depending on coexistent vascular disease. We assessed the stroke rate and predictive value of two published schemes for stroke risk stratification in a population-derived cohort of 259 elderly people with nonvalvular AF followed for a median of 5.3 years. The rate of ischemic stroke was 2.8% per year (95% confidence interval [CI] 1.9, 3.9). Thirty-one percent were predicted to be at low risk, and their stroke rate was 1.7% per year (95% CI 0.6, 3.8). Many people with AF in this population-derived cohort had relatively low rates of stroke. Further studies to reliably stratify stroke risk in patients with AF are needed. [ABSTRACT FROM AUTHOR]

The article analises the main risk factors responsible for the apparition of stroke because this pathology is very frequent and its economico-social costs are very heavy. The main risk factors are represented by hypertension, smoking, alcohol consumption, hyperlipemia and diabetes and they can be modified by a proper medical treatment and changing the lifestyle of the patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk factors and prognosis of stroke in a tertiary care hospital of Peshawar. Design: Descriptive observational study. Place of Duration: Medical department, Khyber teaching hospital Peshawar from June 2005 to august 2006. Material and Methods: A questionnaire was prepared in accordance with the objectives of the study. Questionnaire contained detailed history, General physical examination, and neurological examination. Prognosis of the disease was studied with the help of Glasgow coma scale (severity of unconsciousness) scoring system. Results: One hundred and eighty-three patients with established diagnosis of stroke were selected. Forty-seven (25.68%) had more than one risk factors. The age range of the patients was from 31-92 years with mean age of 57 years. Out of total 111960.65%) were males and 72(39.34%) were females. The distribution of risk factors was: hypertension 95(51.91%), diabetes 56(30.60%), hyperlipidemia 21(11.47%), smoking 23(12.56%), ischemic heart diseases 21(11.47%), atrial fibrillation 5(2.73%), obesity 5(2.73%), physical inactivity 2(1.09%), history of heparin or warfarine 2(1.09%) and history of oral contraceptives 1(0.54%). The prognosis of the disease based on Glasgow coma scale scoring system (severity of unconsciousness) was studied only in 122(66.66%) patients. Out of 122 patients 42.62% had score more than ten, 35.24% scored between 6-10 and 22.13% had score less than five. Conclusion: Hypertension, diabetes, hyperlipidemia and smoking are major modifiable risk factors of stroke in our patients. Of total patients in whom GCS scoring war recorded, more than 50% had unsatisfactory Glasgow coma scale score, which indicates poor prognosis. [ABSTRACT FROM AUTHOR]