ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeStroke is declining in most of the western and northern European countries, whereas no such decline is seen in eastern Europe. The aim of this study was to investigate trends in stroke attack rates and 28-day case fatality and risk factor levels in Novosibirsk, Siberia, and northern Sweden during 1987–1994.MethodsWithin the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, acute stroke events and 28-day case fatality were registered in a standardized way in men and women aged 35 to 69 years. Cardiovascular risk factors were monitored in randomly selected men and women in the group aged 35 to 64 years in 1985–1986 and 1994–1995.ResultsStroke attack rates increased significantly from 430 per 100 000 to 660 (P=0.005) in men in Novosibirsk and from 298 to 500 (P=0.02) in women. In northern Sweden, stroke attack rates varied between 244 and 303 per 100 000 in men and from 117 to 157 in women, with a small increasing trend in women (P=0.03). The mortality rates were 5 times higher in Novosibirsk, and the case fatality was significantly lower in northern Sweden (P=0.0001). The risk factor surveys showed significantly higher blood pressure, overweight, and more smoking men in Novosibirsk, while northern Sweden had higher cholesterol levels and more smoking women. Most risk factors showed stable or improving patterns over time.ConclusionsLarge differences in both attack rates and case fatality account for the large and widening gap in stroke mortality between Russia and Sweden. A higher prevalence of hypertension in Russia may explain much of the differences in stroke occurrence. In Russia, a marked increase in attack rates has occurred despite stable or improving patterns of conventional cardiovascular risk factors.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposePopulation-based data on transient ischemic attack (TIA) incidence are scarce. This study defines incidence rates of first-ever TIA in Novosibirsk, Russia, during 1987–1997 and compares the incidence of first TIA with that of first stroke.MethodsThis is a prospective registry population-based study of all new cases of TIA and stroke in an overall population of 455 765 residents of Novosibirsk. All new TIA and stroke incident cases (whether inpatient or outpatient) that occurred during 1987–1988 and 1996–1997 study periods were recorded and analyzed. A 95% CI was estimated for all age- and sex-specific strata.ResultsDuring the 2 study periods, a total of 211 patients with first TIA were registered in the population studied. The crude annual TIA incidence rate per 100 000 residents was 16 (95% CI, 8 to 33) in 1987–1988 and 29 (95% CI, 9 to 87) in 1996–1997; these rates standardized to the European population were 17 (95% CI, 8 to 34) and 27 (95% CI, 9 to 79), respectively. Eighty-three percent of TIAs occurred in the carotid arteries (rate, 48/100 000), 10% occurred in the vertebrobasilar territory (rate, 6/100 000), and 7% of cases had a TIA of uncertain distribution (rate, 2/100 000).ConclusionsUnlike stroke incidence rate, the incidence rate of TIA in Novosibirsk is similar to that in other populations and constitutes approximately 10% of stroke incidence. For the last decade (1987–1997), there was a tendency, although statistically insignificant, toward increasing incidence rate of TIA in the population studied.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeFew studies have reported a protective effect of physical activity on stroke in women, particularly among elderly women. This study was conducted to examine the association between different levels of leisure-time physical activity and stroke mortality in a large prospective study of middle-aged and elderly women.MethodsWe conducted a 10-year mortality follow-up of women aged ≥50 years, free from stroke at baseline (n=14 101), who participated in the Nord-Trøndelag Health Survey in Norway during 1984–1986. Main outcome measures were relative risk of stroke mortality according to increasing levels of physical activity, with the least active group used as reference.ResultsIn groups aged 50 to 69, 70 to 79, and 80 to 101 years, the relative risk of dying decreased with increasing physical activity, after adjustment for potentially confounding factors. In groups aged 50 to 69 and 70 to 79 years, the most active women had an adjusted relative risk of 0.42 (95% CI, 0.24 to 0.75) and 0.56 (95% CI, 0.36 to 0.88), respectively. In the group aged 80 to 101 years, there was a consistent negative association with physical activity; the adjusted relative risk for the most active was 0.57 (95% CI, 0.30 to 1.09).ConclusionsPhysical activity was associated with reduced risk of death from stroke in middle-aged and elderly women. This association persisted after we excluded individuals with prevalent cardiovascular and cerebrovascular disease at baseline and women who died during the first 2 years of follow-up. These observations strengthen the evidence that physical activity should be part of a primary prevention strategy against stroke in women.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundIn the United States, stroke mortality is higher in the south than in other regions. Hypertension is the main risk factor for stroke among older adults; however, few studies have examined group-specific regional and urbanization differences in hypertension prevalence.MethodsData from the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994, were analyzed to calculate the prevalence of hypertension (systolic >140 mm Hg and/or diastolic >90 mm Hg and/or taking antihypertensive medication) by region and urbanization for age (40 to 59 and 60 to 79 years), sex, and ethnic subgroups. Logistic regression models were fitted to estimate the association of hypertension with region and urbanization.ResultsWith age and urbanization kept constant, southern residence was associated with hypertension among middle-aged non-Hispanic white men (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12 to 1.90;P<0.006), non-Hispanic black men (OR, 1.36; 95% CI, 1.05 to 1.66;P=0.019), and non-Hispanic black women (OR, 1.23; 95% CI, 1.01 to 1.45;P=0.034). Among older non-Hispanic white men, a significant interaction was noted between region and urbanization (P=0.01), with a higher prevalence in the south only for nonmetropolitan residents (OR, 1.32; 95% CI, 1.06 to 1.56;P<0.013). A similar but not statistically significant trend was also confirmed among non-Hispanic black men in logistic regression analysis (OR, 1.38; 95% CI, 0.97 to 1.68;P=0.061). No statistically significant association was observed for urbanization or region in the other subgroups.ConclusionsSouthern residence was associated with increased hypertension prevalence among middle-aged non-Hispanic white men, non-Hispanic black men and women, and older non-Hispanic white men.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeAbnormalities in the fibrinolytic system have been associated with an increased risk for stroke in a few studies. This study was designed to test whether plasma levels of tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA/PAI-1 complex could predict a first-ever stroke.MethodsThe study was an incident case-control study nested within the Västerbotten Intervention Program and the Northern Sweden Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) cohorts. In this study 108 first-ever stroke cases were defined according to the MONICA classification, and 216 controls from the same cohort were randomly selected and matched for age, sex, sampling time, and geographic region.ResultsStroke occurred on average 30 months after the blood sampling date. The mean plasma concentration of tPA/PAI-1 complex was higher for the stroke cases than for the controls (3.9 versus 3.0 &mgr;g/L). In univariate regression analysis, significantly higher odds ratios were found for the tPA/PAI-1 complex as continuous variable. When divided into quartiles, the odds ratio was 2.74 for the highest quartile compared with the lowest. In the multivariate model, the tPA/PAI-1 complex remained an independent predictor for stroke. Additionally, tPA mass concentration quartiles 3 and 4 showed a significant association with all stroke as outcome. No association was found, however, for PAI-1. In subgroup analysis of cerebral hemorrhage (n=18), the mean tPA/PAI-1 complex level was higher for the cases than for the controls (4.8 versus 3.0 &mgr;g/L), and in multivariate analysis including all controls (n=216), only tPA/PAI-1 complex remained significant.ConclusionsThis prospective study shows that tPA/PAI-1 complex, a novel fibrinolytic marker, is independently associated with the development of a first-ever stroke, especially hemorrhagic stroke. This finding supports the hypothesis that disturbances in fibrinolysis precede a cerebrovascular event.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeOxidative stress is probably involved in neuronal damage induced by ischemia-reperfusion. The purpose of this study was to assess the role of antioxidant activity in cerebral ischemic stroke.MethodsAntioxidant activity of blood plasma and cerebrospinal fluid was assessed in 22 patients with cerebral hemisphere infarction that was verified and quantified by MRI.ResultsLow total peroxyl radical trapping potential of plasma, but not of cerebrospinal fluid, was associated with high lesion volume and high neurological impairment assessed by scores on NIH Stroke Scale, Barthel Index, and Hand Motor Score tests. The plasma concentrations of ascorbic acid, &agr;-tocopherol, and protein thiols were also associated with the degree of neurological impairment.ConclusionsThese data suggest that the antioxidant activity of plasma may be an important factor providing protection from neurological damage caused by stroke-associated oxidative stress.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeAcute disruption of atherosclerotic plaques precedes the onset of clinical syndromes, and studies have implicated a role for matrix metalloproteinases (MMPs) in this process. The aim of this study was to establish the character, level, and expression of MMPs in carotid plaques and to correlate this with clinical status, cerebral embolization, and histology.MethodsPlaques were obtained from 75 consecutive patients undergoing carotid endarterectomy and divided into 4 groups according to symptomatology (group 1, asymptomatic; group 2, symptomatic >6 months before surgery; group 3, symptomatic within 1 to 6 months; group 4, symptomatic within 1 month). All patients underwent preoperative and intraoperative transcranial Doppler monitoring. Plaques were subjected to histological examination and quantification of MMPs by zymography and ELISA.ResultsThe level of MMP-9 was significantly higher in group 4 (median 125.7 ng/mL for group 4, median <32 ng/mL for all other groups;P=0.003), with no difference in the levels of MMPs 1, 2, or 3. Furthermore, the MMP-9 concentration was significantly higher in plaques undergoing spontaneous embolization (P=0.019) and those with histological evidence of plaque instability (P<0.03). In situ hybridization demonstrated increased MMP-9 expression in highly symptomatic plaques in areas of intense inflammatory infiltrate.ConclusionsThe concentration, production, and expression of MMP-9 is significantly higher in unstable carotid plaques. If this proves to be a causal relationship, MMP-9 may be a strong candidate for pharmacotherapy aimed at stabilizing plaques and preventing stroke.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeTreatment of hypertension effectively reduces the risk of stroke. However, many treated patients still have high blood pressure (BP), other cardiovascular risk factors, and complications. The risk of stroke in treated hypertensive patients is not well understood.MethodsWe analyzed the level of BP over 1 year before the onset of stroke and other cardiovascular risk factors in treated hypertensive patients in a case-control study. The study population included 126 hypertensive patients (74 men; mean age, 70.9 years) with first strokes during 1988–1993 who had been treated for >1 year before stroke onset (stroke group). As a control group, we selected 126 sex- and age-matched hypertensive patients who were treated during the same period and were free from stroke.ResultsMean 12-month BP was not significantly different between stroke and control groups, although systolic BP was 2.5 mm Hg higher in the stroke group (148.7 [95% CI, 146.1 to 151.3]/82.1 [95% CI, 80.5 to 83.7] versus 146.2 [95% CI, 143.8 to 148.6]/82.4 [95% CI, 81.0 to 83.8] mm Hg). In patients aged <70 years, mean systolic BP was significantly higher in the stroke group than the control group (150.5 [146.3 to 154.7] versus 144.0 (140.6 to 147.4) mm Hg). Mean pulse pressure was also significantly higher in the stroke group than the control group in patients aged <70 years but not in older patients. In the stroke group, the level of BP within 1 month before stroke onset did not differ from the mean value over the 12-month period. Patients with brain hemorrhage had higher diastolic BP than those with other subtypes. The stroke group had higher plasma glucose, lower HDL cholesterol, and higher frequencies of diabetes mellitus, proteinuria, atrial fibrillation (29.4% versus 4.0%), and use of antiplatelet (31.0% versus 11.1%) and anticoagulant (10.3% versus 1.6%) agents than the control group.ConclusionsThe onset of stroke in treated hypertensive patients was related to a higher level of BP in subjects <70 years old, although this relationship was not obvious in older patients. The risk of stroke in these patients was associated with the presence of metabolic risk factors and cardiovascular complications. Office BP did not change significantly 1 month before the onset of stroke.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background and PurposeBoth stroke and the apolipoprotein E (APOE) &egr;4 allele increase the risk of dementia. However, the interaction between stroke and APOE on dementia is still unclear. We addressed this topic by using a longitudinal design.MethodsWe followed up a community cohort of 1301 subjects aged ≥75 years, who did not have dementia at baseline. Among them, 92 subjects had a history of stroke (from 3 months to 16 years before baseline interview). After the 3-year follow-up, 224 dementia cases had been diagnosed. During the period of follow-up, 91 subjects had a first occurrence of stroke (incident stroke). The APOE genotype was known for 985 subjects. Cox proportional hazards regression models were constructed to estimate the risk for dementia in terms of relative risks (RRs) for stroke and the APOE &egr;4 allele, with adjustment for age, sex, education, systolic blood pressure, antihypertensive medication use, and heart disease.ResultsIn the entire study population, RRs for dementia related to history of stroke and incident stroke were 1.7 (95% CI, 1.1 to 2.6) and 2.4 (95% CI, 1.6 to 3.5), respectively, after adjustment for all potential confounders. Subjects with stroke that occurred within 3 years before baseline had RR of 2.4 (95% CI, 1.4 to 4.2), whereas those with stroke occurring >3 years before baseline had RR of dementia of 1.1 (95% CI, 0.6 to 2.3). Among those with APOE information, individuals with only history of stroke (that occurred within 3 years before baseline) had RR of 3.1 (95% CI, 1.4 to 6.6), individuals with only the APOE &egr;4 allele had RR of 1.7 (95% CI, 1.1 to 2.5), and individuals with both factors had RR of 5.3 (95% CI, 2.1 to 13.4). The corresponding figures when incident stroke was examined instead of history of stroke were 2.3 (95% CI, 1.3 to 4.1), 1.7 (95% CI, 1.1 to 2.4), and 4.6 (95% CI, 2.0 to 10.6), respectively. The RR of interaction term for history of stroke and APOE &egr;4 was 1.1 (95% CI, 0.3 to 3.8;P=0.8). The corresponding figure was 1.2 (95% CI, 0.4 to 4.4;P=0.7) for incident stroke and APOE &egr;4. Furthermore, the RRs of dementia without any stroke and dementia with stroke in relation to APOE &egr;4 were 1.6 (95% CI, 1.1 to 2.3) and 1.2 (95% CI, 0.6 to 2.4), respectively. In addition, the APOE &egr;4 allele was not significantly related to the occurrence of stroke (RR=0.8; 95% CI, 0.5 to 1.5).ConclusionsA relatively fresh stroke is a risk factor for dementia. APOE &egr;4 increases the risk of dementia without stroke but not dementia with stroke. Our data do not support a multiplicative effect of stroke and the APOE &egr;4 allele on the risk of dementia. However, both factors seem to have an additive effect on the risk of dementia. The APOE &egr;4 allele does not increase the risk of stroke in this Swedish elderly population.

ISSN:0039-2499    

出版商:OVID    

年代:2000

数据来源: OVID