Stroke最新文献

{"title":"Association Between Schizophrenia and Adherence to Medications for Secondary Stroke Prevention.","authors":"Eshita Kapoor, Kathleen A Sheehan, Amy Y X Yu, Paul Kurdyak, Leanne K Casaubon, Joan Porter, Jiming Fang, Moira K Kapral","doi":"10.1161/STROKEAHA.125.051100","DOIUrl":"10.1161/STROKEAHA.125.051100","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is associated with an increased risk of stroke and under-treatment of vascular risk factors, but less is known about adherence to medications for secondary stroke prevention. We sought to understand current rates of adherence to secondary stroke prevention therapies among elderly ischemic stroke survivors with and without schizophrenia.</p><p><strong>Methods: </strong>In a population-based cohort study, we used administrative databases to identify all patients aged ≥65 years who were hospitalized with ischemic stroke in the province of Ontario, Canada, between 2004 and 2018, and a validated algorithm to identify those with schizophrenia. Among patients who filled a prescription for antihypertensive, lipid-lowering, or anticoagulant medications within 3 months and were alive 1 year after discharge, we compared the proportion with low adherence (defined as an annual proportion of days covered of <0.4) in those with and without schizophrenia. We used multivariable logistic regression to estimate the association between schizophrenia and low adherence adjusting for age, sex, comorbid conditions, area of residence, and socioeconomic status.</p><p><strong>Results: </strong>Of the 55 842 patients included, the mean age was 79.5 years, 53.3% were women, and 1.0% had schizophrenia. Among those who survived to 1 year after discharge, individuals with schizophrenia were more likely than those without to have low adherence to antihypertensive (28.0% versus 18.8%; adjusted odds ratio, 1.60 [95% CI, 1.28-2.01]), lipid-lowering (38.6% versus 29.8%; adjusted odds ratio, 1.60 [95% CI, 1.31-1.96]), or anticoagulant medications (41.1% versus 32.0%; adjusted odds ratio, 1.61 [95% CI, 1.00-2.58]), even after adjustment for age, sex, comorbid illness, rurality, and neighborhood income quintile.</p><p><strong>Conclusions: </strong>Schizophrenia is associated with poor adherence to medications for secondary stroke prevention. Future work should focus on developing individual- and system-level interventions to improve vascular risk factor management in this population.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3090-3094"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faster Thrombolysis Is Associated With Improved Cognitive Outcomes in Patients With Acute Ischemic Stroke Treated With Alteplase and Tenecteplase: A Substudy of the AcT Trial.","authors":"Sajeevan Sujanthan, Gayathiri Rajkumar, Katie N Dainty, Morgan Barense, Krista L Lanctot, Adrian M Owen, Nishita Singh, Brian H Buck, Houman Khosravani, Shelagh B Coutts, Mohammed Almekhlafi, Ramana Appireddy, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, Jennifer Mandzia, Aleksander Pikula, Heather Williams, Thalia S Field, Alejandro Manosalva, Muzaffar Siddiqui, Gary Hunter, MacKenzie Horn, Fouzi Bala, Michael D Hill, Michel Shamy, Aravind Ganesh, Tolulope Sajobi, Bijoy K Menon, Richard H Swartz","doi":"10.1161/STROKEAHA.125.051670","DOIUrl":"10.1161/STROKEAHA.125.051670","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment after stroke is linked with poorer functional outcomes. Faster thrombolytic improves recanalization, 3-month functional recovery, and in-hospital survival. We examined whether faster treatment times from door-to-needle and symptom onset-to-needle (OTN) impacted cognition.</p><p><strong>Methods: </strong>This study is a prespecified secondary observational cohort analysis of the AcT randomized clinical trial (Alteplase Compared to Tenecteplase; URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249) data. Eligible participants were English-speaking individuals who independently completed the trial's primary outcome and were recruited from 18 stroke centers within Canada. Prospective cognitive outcomes were collected at 90 to 180 days using a Telephone Montreal Cognitive Assessment (T-MoCA range, 0-22; <17 impairment). The primary aim was to assess cognitive performance and its relationship with treatment times (door-to-needle and OTN) at 90 to 180 days. Linear and logistic regression analyses were used to evaluate the relationship, adjusting for treatment allocation, age, sex, baseline National Institutes of Health Stroke Scale, education, ethnicity, and occlusion location.</p><p><strong>Results: </strong>Three hundred ninety-nine (50%) of 791 eligible subjects completed the T-MoCA. The mean age was 66±13 years, 38.8% were female, and the mean T-MoCA score was 16±4. Shorter OTN times (but not door-to-needle) were associated with higher T-MoCA scores on linear regression (β, -0.009 [95% CI, -0.016 to -0.002]) and with increased odds of T-MoCA impairment for every 1-minute increase on logistic regression (odds ratio, 1.005 [95% CI, 1.001-1.009]). There was no difference between the alteplase and tenecteplase subgroups in the relationship between treatment times and cognition. Each 15-minute reduction in OTN was associated with a 7.3% reduction in the probability of impairment (score <17) on the T-MoCA.</p><p><strong>Conclusions: </strong>Faster OTN time, with either alteplase or tenecteplase, was associated with higher T-MoCA scores and reduced the likelihood of impairment at 90 days. Faster thrombolytic treatment may reduce cognitive burden after stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2858-2865"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers of Thromboelastography Platelet Mapping Predict Hematoma Expansion After Spontaneous Intracerebral Hemorrhage.","authors":"Kaleigh M Copenhaver, Juliana Silva Pinheiro do Nascimiento, Rajeev K Garg, Fernando D Goldenberg, Harish Shownkeen, Matthew B Potts, Babak S Jahromi, Paul F Lindholm, Andrew M Naidech","doi":"10.1161/STROKEAHA.125.051447","DOIUrl":"10.1161/STROKEAHA.125.051447","url":null,"abstract":"<p><strong>Background: </strong>Hematoma expansion (HE) is a preventable cause of disability and death in patients with acute intracerebral hemorrhage (ICH). Platelet activity is essential for coagulation, and antiplatelet medications (eg, aspirin, clopidogrel) increase HE risk. General markers of platelet activity are associated with later HE, but specific biomarkers of platelet activity could enhance our understanding. We hypothesized that hemostatic biomarkers of platelet activity would correlate with later HE.</p><p><strong>Methods: </strong>We conducted a tri-center observational cohort study of spontaneous ICH patients with multiple imaging scans for HE calculation. The thromboelastography 6s Platelet Mapping assay assessed platelet activity with 3 biomarkers: (1) adenosine diphosphate receptor-induced platelet activation, (2) platelet-fibrin network clot strength measured by heparinized kaolin with heparinase, and (3) fibrinogen-only clot strength measured by activator F (ActF). Spearman rank measured the correlation between HE and platelet activity. A linear regression model predicted HE from ActF. We tested whether the relationship between ActF and HE interacted with pre-ICH antiplatelet medication.</p><p><strong>Results: </strong>Thirty-five patients were included. Eleven (35.48%) took pre-ICH antiplatelet medication. Heparinized kaolin with heparinase negatively correlated with HE (<i>ρ</i>=-0.34, <i>P</i>=0.02), indicating that stronger platelet-fibrin clots were associated with less subsequent HE. ActF's association with HE depended on pre-ICH antiplatelet medication use (interaction <i>P</i>=0.005). More ActF (fibrinogen) was associated with less HE in patients who did not take pre-ICH antiplatelet medication.</p><p><strong>Conclusions: </strong>Hemostatic biomarkers from the thromboelastography 6s Platelet Mapping assay predicted subsequent HE and may aid in determining neurosurgical need. Strengthening platelet-mediated coagulation may be a target for reducing HE and improving ICH outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3084-3089"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Training Across the Globe: Opportunities and Challenges in Various Countries.","authors":"Maria Khan, Ahmed Abdelalim, Wan Asyraf Wan Zaidi, Rufus Akinyemi, Eva Rocha","doi":"10.1161/STROKEAHA.124.048856","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048856","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e295-e297"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strokophobia: Implications for Stroke Care in Low- and Middle-Income Countries.","authors":"Oladotun V Olalusi, Tobi Olajide, Samuel Olawale, Obinna Amaji, Joseph Yaria","doi":"10.1161/STROKEAHA.125.051582","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051582","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e291-e294"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could the Early Disinhibition of the Unaffected Motor Cortex Predict Motor Recovery After Stroke?","authors":"Charlotte Rosso, Lina Daghsen, Justine Bouvier, Thomas Checkouri, Sarah Millot, Flore Baronnet, Damien Galanaud, Romain Valabregue, Pierre Pouget, Jean-Charles Lamy, Emmanuel Roze","doi":"10.1161/STROKEAHA.125.051614","DOIUrl":"10.1161/STROKEAHA.125.051614","url":null,"abstract":"<p><strong>Background: </strong>Whether intracortical inhibition in the unaffected hemisphere is related to motor recovery after stroke may depend on the status of corticospinal excitability in the affected hemisphere. The aims are (1) to identify the presence of short-latency intracortical inhibition (SICI) in the acute phase according to the motor-evoked potential (MEP) status of the patients and (2) to investigate whether unaffected hemisphere SICI is associated with motor recovery at 3 months in subgroups of patients (with or without an MEP).</p><p><strong>Methods: </strong>We enrolled 95 patients with stroke (median age, 68 years; interquartile range, 61-78 years, sex: 61% males, n=58) with upper extremity weakness persistent on day 3 and analyzed 83 patients (median age, 67 years; interquartile range, 59-77 years, sex: 65% males, n=54) in this single-center study (from August 2022 to May 2024). Transcranial magnetic stimulation was performed before day 7 to determine the presence of MEP and to record SICI in both hemispheres. The motor evaluation was performed on day 7 using the Fugl-Meyer Assessment of the Upper Extremity and at 3 months by the Fugl-Meyer Assessment of the Upper Extremity and the Action Research Arm Test.</p><p><strong>Results: </strong>SICI was present in the unaffected hemisphere in 58% of MEP- patients (patients with no evocable MEP in the first dorsal interosseous; n=14/24) and 57% of MEP+ patients (patients with evocable MEP in the first dorsal interosseous; n=33/57, 2 missing data). The presence of SICI in the unaffected hemisphere in MEP- patients (but not in MEP+) was associated with better motor recovery (Spearman rank coefficient, -0.514 [95% CI, -0.774 to -0.106]; <i>P</i>=0.017) and was an independent predictor of motor recovery on a stepwise multiple linear regression, along with the Fugl-Meyer Assessment of the Upper Extremity at day 7 (<i>R</i>²=54%, <i>P</i>=0.002).</p><p><strong>Conclusions: </strong>Implementing intracortical inhibition could improve prediction models in future studies for severe patients without an MEP whose recovery trajectories are hard to predict and for whom clinical rehabilitation decisions are difficult to make.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2904-2913"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence: A Scientific Statement From the American Heart Association.","authors":"Eric E Smith, Hugo J Aparicio, Rebecca F Gottesman, Manu S Goyal, Steven M Greenberg, Julie A Schneider, Farzaneh A Sorond, Clinton B Wright","doi":"10.1161/STR.0000000000000494","DOIUrl":"10.1161/STR.0000000000000494","url":null,"abstract":"<p><p>Vascular contributions to cognitive impairment and dementia (VCID) are common and may be the most preventable cause of clinically significant cognitive decline. However, an estimate of the prevalence and incidence of VCID in the United States is lacking. In this scientific statement, we reviewed studies on the incidence and prevalence of VCID, defined as patients diagnosed with vascular dementia, evidence of vascular dementia in epidemiological studies, neuropathological evidence of cerebrovascular contributions to dementia, and neuroimaging evidence of covert (clinically silent) cerebrovascular disease. We found variability in estimates of vascular dementia, with a higher prevalence in prospective epidemiological and autopsy-based studies than studies of physician diagnoses. There were many more studies of vascular contributions to dementia than to mild cognitive impairment. Epidemiological studies suggest that in the 2020 US population >65 years of age, 2.7 million individuals were living with vascular dementia or mixed dementia with a vascular contribution, whereas health care billing data suggest that 809 000 people were diagnosed with vascular dementia. In 2020, as many as 603 000 new individuals developed new vascular dementia or mixed vascular dementia according to epidemiological studies, whereas there were 102 000 new cases according to health care billing data. In addition, we estimate that in 2020 there were 11.3 million people with covert brain infarcts, 11.1 million with high volumes of white matter hyperintensity, and 19.9 million with cerebral microbleeds potentially detectable by magnetic resonance imaging, contributing to VCID. These covert cerebrovascular lesions may be preventable with appropriate risk factor modification. Indeed, we estimate that eliminating cerebrovascular disease from the population would prevent 27% to 33% of dementia cases, resulting in 1.5 to 1.8 million fewer people with dementia in 2020. Population health approaches to reduce VCID would benefit millions of Americans.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e317-e330"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Versus State-Level Racial Disparities in Acute Stroke Interventions Using Get With The Guidelines-Stroke Data.","authors":"Jennifer A Kim, Alison Herman, Peter Shrader, Brooke Alhanti, Ying Xian, Guido J Falcone, Brian Mac Grory, Eric E Smith, Steven R Messe, Adam de Havenon, Gregg C Fonarow, Kevin N Sheth","doi":"10.1161/STROKEAHA.124.050446","DOIUrl":"10.1161/STROKEAHA.124.050446","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities have been reported in stroke care, but understanding if there is regional variability is critical to focusing policies and resources. Here, we sought to study racial and ethnic inequity in the administration of thrombolysis and thrombectomy at the national and state levels.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using Get With The Guidelines-Stroke Program registry data from 2003 to 2022 to evaluate racial disparities in the administration of acute stroke treatments in US patients. We used mixed-effects modeling to analyze national and state-level disparities, adjusting for relevant demographic, clinical, and hospital-level characteristics.</p><p><strong>Results: </strong>A total of 660 369 patients were eligible for thrombolysis and 105 184 patients for thrombectomy. The mean age was 70.21±14.48 years, and 50.18% were female. The race/ethnic distribution was 69.06% of non-Hispanic White, 16.88% of non-Hispanic Black, 7.02% of Hispanic, 2.84% of Asian, and 4.20% of American Indian/Alaska Native/Hawaiian/Pacific Islander patients. Eligible non-Hispanic Black patients had statistically higher thrombolytic rates compared with non-Hispanic White patients (adjusted odds ratio [aOR], 1.04 [95% CI, 1.03-1.06]), indicating no racial disparities in thrombolytic treatment at the national level. Similarly, equal or higher rates of thrombolytic administration were noted in other race/ethnic groups at the national level (Asian: aOR, 1.12 [95% CI, 1.09-1.16]; Hispanic: aOR, 1.14 [95% CI, 1.12-1.17]; and other: aOR, 1.10 [95% CI, 1.07-1.13]; <i>P</i><0.0001). However, when non-Hispanic Black patients were compared with non-Hispanic White patients at the individual state level, there were disparities in many of the stroke-belt states. Racial disparities remained significant at the national level between non-Hispanic Black and non-Hispanic White patients and eligible thrombectomy patients after adjusting for patient- and hospital-level covariates (aOR, 0.85 [95% CI, 0.82-0.89]; <i>P</i><0.0001).</p><p><strong>Conclusions: </strong>These data suggest that racial/ethnic disparities in stroke care vary depending on the intervention and geographic location. Equitable utilization of thrombolysis nationally may underscore the benefits of quality improvement initiatives though state-level inequities persist. Endovascular thrombectomy utilization demonstrated race-based disparities in use, and further efforts are needed to ensure equitable care of patients with stroke in the United States.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2945-2956"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maintaining Balance: An Update on Nonpharmacological Cytoprotection Therapy for Acute Ischemic Stroke.","authors":"Yi Xu, Wenbo Hu, Xi Chen, Chen Zhou, Wenbo Zhao, Chuanjie Wu, Yang Zhang, Shuaili Xu, Baoying Song, Jean-Claude Baron, Xunming Ji, Di Wu","doi":"10.1161/STROKEAHA.125.051589","DOIUrl":"10.1161/STROKEAHA.125.051589","url":null,"abstract":"<p><p>Reperfusion therapies have become the standard of care for patients with acute ischemic stroke (AIS). However, around half of treated patients do not regain functional independence despite successful recanalization. Potentially avoidable unbalanced states that prevail both before and after reperfusion therapy might account for such unfavorable functional outcomes. They include energy supply versus energy demand in the ischemia phase, hypoperfusion versus hyperperfusion in the reperfusion phase, and acute cytotoxic versus prorepair inflammation in subacute and chronic stages. Classical pharmacological approaches only target one of these imbalances, which is insufficient. Nonpharmacological therapies are typically multitargets and have provided new evidence for benefit in AIS. This topical review discusses the latest evidence regarding nonpharmacological strategies for brain cytoprotection in AIS targeting the 3 above imbalances. We also focus on the mechanisms underlying the benefits of nonpharmacological therapies and present promising results from recent large-scale clinical trials testing them in AIS. We further elaborate on the prospects of several nonpharmacological brain protection strategies applied in the different AIS scenarios. By gaining a deeper understanding of the imbalanced states in AIS and the advantages of nonpharmacological brain cytoprotection therapies, future clinical trials may be further refined to translate nonpharmacological brain cytoprotection therapies to the clinic.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e240-e253"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Morbidity Clusters in Midlife on Ischemic Stroke Incidence and Severity: The ARIC Study.","authors":"Marco Egle, Renee C Groechel, Michelle C Johansen, Anna M Kucharska-Newton, Rebecca F Gottesman, Silvia Koton","doi":"10.1161/STROKEAHA.124.049496","DOIUrl":"10.1161/STROKEAHA.124.049496","url":null,"abstract":"<p><strong>Background: </strong>There is a strong association between vascular risk factors, particularly in midlife, and stroke risk; therefore, the co-occurrence of multiple risk factors may be especially informative. This study used a machine-learning-based cluster analysis to group individuals into clusters based on similar clinical profiles in midlife and assessed the clusters' associations with stroke risk and severity.</p><p><strong>Methods: </strong>Participants (N=15 404) without prevalent stroke from the ARIC study (Atherosclerosis Risk in Communities) were included. An unsupervised agglomerative hierarchical clustering approach was used to allocate participants into clusters based on the presence of clinical risk factors in midlife: hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation, renal dysfunction, and peripheral artery disease. Clusters were then characterized by their defining features. In Cox proportional hazard models, the association of the clusters with overall stroke incidence (and with ischemic stroke incidence stratified by stroke severity) was tested. Multinomial logistic regression models were used to examine the association of morbidity clusters with outcomes of no stroke, stroke before the age of 70 years, and stroke at age of ≥70 years.</p><p><strong>Results: </strong>Of 1424 incident ischemic strokes diagnosed from baseline (1987-1989) to December 31, 2020, 1104 included National Institutes of Health Stroke Scale (NIHSS) grading (minor-mild stroke: NIHSS score ≤5 [n=687]; moderate-severe stroke: NIHSS score >5 [n=417]). The cluster analysis identified 9 distinct clusters in the population with defining features: cluster 1 (relatively healthy); cluster 2 (smoking); cluster 3 (cancer); cluster 4 (peripheral artery disease); cluster 5 (obesity, diabetes, hypertension, and hypertriglyceridemia); cluster 6 (coronary heart disease); cluster 7 (atrial fibrillation); cluster 8 (heart failure); and cluster 9 (renal dysfunction). Compared with cluster 1, clusters 2 to 9 were each associated with a greater stroke risk, with the largest effect estimate for cluster 9 (hazard ratio, 3.00 [95% CI, 2.00-4.50]). The association with moderate-severe stroke incidence (versus no stroke) was also strongest for cluster 9 (hazard ratio, 4.78 [95% CI, 2.62-8.74]). Except for cluster 5 (which was associated with stroke at any age), all midlife morbidity clusters were associated with greater stroke risk before the age of 70 years but not after the age of 70 years.</p><p><strong>Conclusions: </strong>The findings emphasize the importance of morbidity clusters in midlife for stroke incidence and severity.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2928-2941"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}