Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Major cardiovascular events and all-cause mortality after ischemic stroke in central Norway – A three-year prospective multicenter study","authors":"Ailan Phan ,&nbsp;Bent Indredavik ,&nbsp;Stian Lydersen ,&nbsp;Torunn Askim ,&nbsp;Torgeir Wethal","doi":"10.1016/j.jstrokecerebrovasdis.2025.108356","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108356","url":null,"abstract":"<div><h3>Background</h3><div>A substantial decline in the incidence of stroke and ischemic heart disease during the last decade is probably due to improved preventive treatment and a reduction in cardiovascular risk factors. Updated estimates on long-term outcomes following first-ever ischemic stroke are therefore limited.</div></div><div><h3>Purpose</h3><div>To assess the incidence of major cardiovascular events and all-cause mortality three years post-stroke, and to evaluate the impact of modifiable cardiovascular and other prognostic factors.</div></div><div><h3>Methods</h3><div>MIDNOR STROKE is a multicenter prospective study including patients with first-ever ischemic stroke admitted to stroke units in Central Norway during 2015-2017. Data were collected during the hospital stay. Information on major cardiovascular events and survival three years post-stroke was retrieved from national medical registries. Competing risk models were used to analyze cardiovascular events. All-cause mortality was analyzed by using Kaplan-Meier and Cox regression.</div></div><div><h3>Results</h3><div>Among 787 included participants, the cumulative incidence of major cardiovascular events was 15.0 % (95 % CI: 12.0–17.0 %), with recurrent stroke as the most common event. The all-cause mortality rate was 18.0 % (95 % CI: 15.0–20.0 %). Coronary artery disease was associated with a higher risk of major vascular events HR: 1.59, 95 % CI: 1.06, 2.38) and all-cause death (HR: 1.66, 95 % CI: 1,11, 2.50). NIHSS at day 1 predicted all-cause mortality (HR: 1.08, 95 % CI: 1.05, 1.10).</div></div><div><h3>Conclusion</h3><div>Three-year survival rates post-stroke were higher compared to previous reports; however, the risk of major cardiovascular events remains substantial, affecting 15 % of stroke survivors within three years.</div><div>Reducing cardiac disease risk and interventions aimed at minimizing stroke severity may improve long-term stroke outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108356"},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient reported outcomes of cerebral venous thrombosis compared to ischemic stroke","authors":"Hyunjun Ahn BS ,&nbsp;Yadi Li MEd ,&nbsp;Brittany Lapin PhD, MPH ,&nbsp;Maximos McCune BA ,&nbsp;Irene Katzan MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108354","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108354","url":null,"abstract":"<div><h3>Purpose</h3><div>Although both cerebral venous thrombosis (CVT) and ischemic stroke involve cerebrovascular flow disruption, they differ in pathophysiology, clinical features, and outcomes. This study compared patient-reported outcomes (PROs) and their trajectories over time between CVT and ischemic stroke patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients hospitalized for CVT or ischemic stroke who completed at least one of the following PRO in cerebrovascular clinic between January 2019 and April 2024: Patient Health Questionnaire-9, PROMIS Global Health, Neuro-QoL cognitive function, and PROMIS scales for pain interference, physical function, social role satisfaction, fatigue, self-efficacy and sleep disturbance. CVT patients were matched (1:3) with ischemic stroke patients by propensity scores. PROs were compared over time using mixed-effects models.</div></div><div><h3>Results</h3><div>Of 72 CVT and 2,533 ischemic stroke patients, 69 CVT and 196 ischemic stroke patients were included after matching (average age 47.5 ± 17.0 years, 62.6% female, median modified Rankin score 1). Brain tissue injury occurred in 30.6% of CVT patients. Both groups exhibited comparable PROs, but CVT patients reported worse pain interference, and worsening PROMIS global mental health and health-related quality of life over time compared to ischemic stroke patients.</div></div><div><h3>Conclusions</h3><div>Despite favorable functional outcomes and lower rates of brain injury, CVT patients had worse or comparable PROs in severity and patterns compared to the subset of ischemic stroke patients with similar baseline characteristics. Traditional clinical assessments may not fully capture the impact of CVT, and a holistic care approach addressing broader spectrum of outcomes, in addition to vascular pathology, could be beneficial.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108354"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of the Hs-CRP/HDL-C ratio with stroke among US adults: Evidence from NHANES 2015–2018","authors":"Qinghui Feng ,&nbsp;Chanchan Miao ,&nbsp;Xuejun Gao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108353","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108353","url":null,"abstract":"<div><h3>Background</h3><div>The high-sensitivity C-reactive protein (Hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio, which integrates insights into inflammation and lipid metabolism, serves as a comprehensive indicator. The association between this ratio and stroke prevalence is endeavored to be explored in this research.</div></div><div><h3>Methods</h3><div>Drawing on information gathered during the 2015-2018 cycles of the NHANES, the association between the Hs-CRP/HDL-C ratio and stroke was examined through multivariate logistic regression. Additionally, subgroup analysis, interaction test, and restricted cubic spline (RCS) were carried out. Multiple machine learning methods were used to identify the key factors affecting stroke and combined with Shap interpretable models to determine the degree of influence of the key factors. Finally, the results of the logistic regression analysis are used to construct a predictive model, which is represented using a nomogram.</div></div><div><h3>Results</h3><div>This research sample comprised 8,064 participants, yielding a stroke prevalence of 4.04%. A positive correlation was shown between the Hs-CRP/HDL-C ratio and stroke (OR: 1.17, 95% CI: 1.02, 1.35). Interaction tests demonstrated that younger participants were more sensitive to higher Hs-CRP/HDL-C ratios, with a significant interaction in stroke. The RCS analysis indicated a nonlinear association between the exposure variable and to outcome variable. The AUC &gt; 0.8 for a random forest model and an XGBoost model demonstrated their strong predictive value. Ultimately, the generated predictive model is a visual nomogram with an AUC of 0.799.</div></div><div><h3>Conclusion</h3><div>The results of the study showed a positive correlation between Hs-CRP/HDL and the prevalence of stroke, with higher Hs-CRP/HDL levels associated with a higher likelihood of stroke. As a stroke prediction model incorporating Hs-CRP/HDL, the nomogram may play a significant role in the early identification of high-risk populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108353"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TyG-BMI and TyG/BMI %: valuable evaluation tools for predicting unfavorable prognosis in ischemic stroke patients with large vessel occlusion after endovascular therapy","authors":"Jianru Li ,&nbsp;Shandong Jiang ,&nbsp;Peizheng Guo ,&nbsp;Weibo lin ,&nbsp;Jun Yu ,&nbsp;Liang Xu ,&nbsp;Xu Li ,&nbsp;Xianyi Chen ,&nbsp;Bin Fang ,&nbsp;Cong Qian ,&nbsp;Jing Xu ,&nbsp;Zhongju Tan ,&nbsp;Chaohui Jing ,&nbsp;Gao chen","doi":"10.1016/j.jstrokecerebrovasdis.2025.108352","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108352","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance (IR) indices, such as triglyceride-glucose (TyG) and TyG with body mass index (TyG-BMI), are strongly associated with all-cause mortality (ACM) from ischemic or hemorrhagic stroke. However, the relationship between IR indices and adverse outcomes of ischemic stroke patients remains unclear, and no studies have explored whether the TyG/BMI ratio is more predictive than TyG-BMI.</div></div><div><h3>Methods</h3><div>In this study, we calculated four IR-related indicators and followed up regularly to assess modified Rankin Scale (mRS) scores. Multivariate logistic regression analyses were used to explore the associations of these indicators with adverse outcomes at 3 and 12 months. Restrictive cubic splines (RCS) evaluated the dose-effect relationships. Subgroup analyses assessed the prognostic efficacy of TyG-BMI and TyG/BMI %, with favorable outcomes defined as mRS scores of 0–2.</div></div><div><h3>Results</h3><div>Of the 823 patients, 603 were included in the study cohort, with 331 (54.89 %) unable to live independently at 3 months (mRS&gt;2). Among the four IR indexes, lower TyG-BMI and higher TyG/BMI % were significantly associated with poor prognosis after EVT, particularly at 12 months, showing linear or S-shaped dose-response relationships. TyG-BMI and TyG/BMI % improved the accuracy and efficiency of predicting prognosis at 3 and 12 months by enhancing IDI and NRI. In subgroup analyses, TyG/BMI % was effective across most subgroups, except for sex, indicating broad applicability in managing stroke outcomes.</div></div><div><h3>Conclusion</h3><div>Both TyG-BMI and TyG/BMI % were significantly associated with prognosis of patients with AIS-LVO after EVT, particularly at the 12-month follow-up. Notebly, TyG/BMI % exhibited a more favorable trend in predictive performance and risk stratification capability.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108352"},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleepiness, fatigue, and obstructive sleep apnea in stroke patients","authors":"Jeppe Suusgaard MD ,&nbsp;Anders Sode West MD PhD ,&nbsp;Rune Frandsen MD PhD ,&nbsp;Helle Klingenberg Iversen MD DMSc ,&nbsp;Christina Kruuse MD DMSc ,&nbsp;Katrin Rauen MD DMSc ,&nbsp;Belle Mia Ingerslev Loft PhD ,&nbsp;Camilla Dysted RN ,&nbsp;Poul Jørgen Jennum MD DMSc","doi":"10.1016/j.jstrokecerebrovasdis.2025.108345","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108345","url":null,"abstract":"<div><h3>Objectives</h3><div>Obstructive sleep apnea (OSA) impacts approximately 70 % of stroke patients, often causing fatigue and sleepiness. Although continuous positive airway pressure (CPAP) reduces sleepiness, systematic OSA screening is not standard in post-stroke care, and the effect of untreated OSA on fatigue is unclear. This study investigated changes in sleepiness and fatigue among OSA patients following ischemic stroke or transient ischemic attack (TIA) who underwent CPAP treatment.</div></div><div><h3>Methods</h3><div>This prospective multi-center cohort study, ischemic stroke and TIA patients were screened for OSA using respiratory polygraphy. CPAP-eligible patients (Apnea-Hypopnea Index ≥15) were assessed with the Epworth Sleepiness Scale (ESS) and Visual Analogue Scale–Fatigue (VAS–F) at baseline and seven to eight months post-stroke. CPAP compliance was classified into high (≥70 %), moderate (50–69 %), and low (&lt;50 %) compliance based on nights using CPAP more than four hours per night. Poisson regression models analyzed differences in ESS and VAS–F between compliance groups, with low-compliance as the reference.</div></div><div><h3>Results</h3><div>Of 2605 patients, 1518 (mean age: 70 ± 12 years; 61 % male) were screened, and 648 were CPAP-eligible. At follow-up, 333 patients were assessed (49 % lost to follow-up). Sleepiness significantly decreased in the high-compliance group compared to low-compliance (<em>p</em> &lt; 0.001). Fatigue levels decreased across all compliance groups, but no differences were observed between groups.</div></div><div><h3>Conclusions</h3><div>High CPAP compliance in post-stroke or TIA patients with OSA was associated with a reduction in sleepiness but not fatigue. These findings support the recommendation to systematically screen post-stroke patients for OSA and encourage CPAP compliance to mitigate sleepiness.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108345"},"PeriodicalIF":2.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Various sociodemographic variables on acute and inpatient stroke care","authors":"Glenn Goodwin DO ,&nbsp;Henry Yelkin DO ,&nbsp;McHenry Mauger MS ,&nbsp;David Filippi MD ,&nbsp;Ayah Badawy ,&nbsp;Jonghoon Chang MS ,&nbsp;Benjamin Leicht DO ,&nbsp;Erin Marra MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108350","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108350","url":null,"abstract":"<div><h3>Background</h3><div>Key factors affecting stroke outcomes include swift diagnosis and early treatment, however, disparities in symptom recognition, particularly in minority groups, impact timely care. This study examines the influence of patient characteristics on stroke metrics, focusing on factors such as age, sex, ethnicity, race, insurance status, and language preference.</div></div><div><h3>Methods</h3><div>We conducted a multicenter, retrospective study using the National Hospital Corporation of America (HCA) database, analyzing 37,956 acute ischemic stroke (AIS) cases from 170 HCA hospitals between 2017 and 2022. We evaluated the impact of demographic and patient-specific factors on tPA administration rates, time-to-tPA (TtPA), and hospital length of stay (LOS). Statistical methods included odds ratios, one-way ANOVA, mixed-effects models, and negative binomial regression.</div></div><div><h3>Results</h3><div>Factors affecting tPA administration included age, sex, and insurance status. Patients aged 45 and older and those with Medicaid or Medicare were less likely to receive tPA. NIH Stroke Scale (NIHSS) scores significantly influenced tPA administration rates and TtPA. Language preference did not impact tPA administration rates or TtPa, but non-English speakers experienced longer hospital stays. Hispanic and Black patients also had longer LOS compared to non-Hispanic and White patients, respectively.</div></div><div><h3>Conclusion</h3><div>This study underscores the need for targeted interventions to address disparities in stroke management and outcomes. Future research should explore the underlying causes of these differences and develop strategies to enhance stroke care equity across diverse patient populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108350"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of peripheral blood inflammatory biomarkers and poor clinical outcomes in adult stroke patients with moyamoya disease","authors":"Xiaoju Wu ,&nbsp;Rilan Huang ,&nbsp;Shanghua Su ,&nbsp;Xiaoling Li ,&nbsp;Xiaozuo Lin ,&nbsp;Pingkai Wang ,&nbsp;Zhaoju Hong ,&nbsp;Ruoxi Zheng ,&nbsp;Yinan Zeng ,&nbsp;Chaojue Huang ,&nbsp;Man Luo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108351","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108351","url":null,"abstract":"<div><h3>Purpose</h3><div>Stroke is the common manifestation of moyamoya disease (MMD). The study aimed to explore the correlation between inflammatory biomarkers and the poor clinical outcomes in adult stroke patients with MMD.</div></div><div><h3>Patients and methods</h3><div>The retrospective study included adult patients with MMD who were admitted to the First Affiliated Hospital of Guangxi Medical University from June 2012 to November 2023. Functional outcomes were assessed using the modified Rankin Scale (mRS) score. We assessed the area under the curves (AUC) for platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII) and neutrophil-to-albumin ratio (NAR) in predicting the poor clinical outcomes.</div></div><div><h3>Results</h3><div>Overall 201 eligible MMD patients including 29 subjects without stroke, 97 subjects with ischemic stroke and 75 subjects with hemorrhagic stroke were collected. In MMD patients with ischemic stroke, those with poor outcomes had significantly higher levels of SII and NAR. The AUCs of SII and NAR were respectively 0.667 and 0.684, while the AUC for joint application was 0.683. In MMD patients with hemorrhagic stroke, those with poor outcomes had significantly higher levels of PLR, NLR, MLR, SII, and NAR. And the AUCs were respectively 0.678, 0.727, 0.643, 0.751, 0.744, while the AUC for joint application of these inflammatory biomarkers was 0.793, higher than a single indicator.</div></div><div><h3>Conclusion</h3><div>Higher SII and NAR levels were associated with poor clinical outcomes in MMD patients with ischemic stroke. Higher PLR, NLR, MLR, SII, and NAR levels were associated with poor clinical outcomes in MMD patients with hemorrhagic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108351"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends and forecasts in stroke at global, regional and national levels","authors":"Nannan Qian ,&nbsp;Chengcheng Lu ,&nbsp;Taohua Wei ,&nbsp;Wenming Yang ,&nbsp;Han Wang ,&nbsp;Huaizhen Chen ,&nbsp;Jun Li ,&nbsp;Sihuan Zhu ,&nbsp;Weiqi Wang ,&nbsp;Ningshu Shao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108347","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108347","url":null,"abstract":"<div><h3>Background</h3><div>Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.</div></div><div><h3>Methods</h3><div>The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.</div></div><div><h3>Results</h3><div>From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.</div></div><div><h3>Conclusion</h3><div>Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108347"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin initiation and early stroke recurrence in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial (POINT) trial population","authors":"Elham Azizi MD ,&nbsp;Shyam Prabhakaran MD,&nbsp;James R. Brorson MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108349","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108349","url":null,"abstract":"<div><h3>Background</h3><div>Benefits of statin therapy in reducing the long-term risk of ischemic stroke are well-established, but the immediate protective effect of statin therapy on risks of early stroke recurrence after an initial ischemic event are not established.</div></div><div><h3>Methods</h3><div>In this secondary analysis of POINT data, we evaluated the effects of statins on early stroke recurrence (within 7 days) and recurrence over 90 days. We also examined the effect of early statin initiation in the subgroup of subjects not on statins prior to the index event, using logistic and proportional hazards models.</div></div><div><h3>Results</h3><div>In the POINT trial, 175 of 267 (65.5 %) of ischemic stroke recurrences were early (within 7 days). Baseline statin treatment at the time of study entry was associated with decreased odds of early ischemic stroke recurrence in adjusted logistical regression analysis (OR 0.70, 95 % CI 0.50–0.99, <em>P</em> = 0.04), an effect only marginally significant in adjusted Cox proportional hazard analyses (HR 0.72, 95 % CI 0.52–1.01, <em>P</em> = 0.05). In the subset of subjects not taking statin medications at baseline, initiation of statin treatment had no significant protective effect against early stroke recurrence (adjusted HR 0.80, 95 % CI 0.54–1.20, <em>P</em> = 0.28).</div></div><div><h3>Conclusions</h3><div>In the POINT trial population, prior treatment with statin was marginally associated with decreased odds of early recurrence of stroke. However initiating statin treatment had no detectable effect in reducing risk of early stroke recurrence. The POINT trial provides no evidence for an immediate protective effect of statin initiation against early stroke recurrence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108349"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the association between visit- to- visit heart rate variability and cardiovascular disease mediated by arteriopathy as measured by carotid intima- media thickness?","authors":"Johanna Härtl ,&nbsp;Dirk Sander ,&nbsp;Ikenberg David Ikenberg ,&nbsp;Georg Schmidt ,&nbsp;Bernhard Hemmer ,&nbsp;Silke Wunderlich ,&nbsp;Bernhard Nimmrichter ,&nbsp;Klaus Pürner ,&nbsp;Alexander Hapfelmeier","doi":"10.1016/j.jstrokecerebrovasdis.2025.108348","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108348","url":null,"abstract":"<div><h3>Background</h3><div>Visit-to-visit heart rate variation (HRV-VV) is associated with mortality and cardiovascular events. Mechanisms of the interaction between HRV-VV and vascular disease are not clearly understood. Our study aimed to evaluate the association between HRV-VV and carotid intima-media thickness (IMT) and their potential impact on cardiovascular disease development.</div></div><div><h3>Methods</h3><div>The study population is derived from a cohort of elderly patients enrolled in the primary-care-based INtervention project on cerebroVAscular diseases and Dementia in the community of Ebersberg (INVADE). We included all patients with a follow-up of eight years and five follow-up visits in regular two-year intervals. HRV-VV was defined by the standard deviation of between-visit measurements (SD). Uni- and multivariable regression models were used to identify associations between HRV-VV, IMT, and a combined cardiovascular endpoint of new onset stroke and myocardial infarction.</div></div><div><h3>Results</h3><div>2815 patients were included in the study. HRV-VV was positively associated with IMT in multivariable analysis (<em>p</em> = 0.026). Every SD HRV-VV of 10 bpm was associated with a change of IMT of 18 ± 8 µm. Furthermore, HRV-VV showed a numerical and positive association with the combined cardiovascular endpoint (<em>p</em> = 0.07), while a simultaneous increase in HRV-VV and IMT increased the likelihood more than either factor alone (<em>p</em> = 0.009).</div></div><div><h3>Conclusion</h3><div>HRV-VV showed a positive association with IMT, a surrogate marker for early arteriopathy. Both parameters furtherly demonstrated a synergistic impact on the likelihood of cardiovascular disease development. Given its widespread availability by continuous monitoring with wearables, HRV-VV may provide a potentially modifiable medical target for personalized cardiovascular risk stratification.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108348"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}