This online calculator can predict your stroke risk
August 14, 2020
Science Daily/University of Virginia Health System
Doctors can predict patients' risk for ischemic stroke based on the severity of their metabolic syndrome, a conglomeration of conditions that includes high blood pressure, abnormal cholesterol levels and excess body fat around the abdomen and waist, a new study finds.
The study found that stroke risk increased consistently with metabolic syndrome severity even in patients without diabetes. Doctors can use this information -- and a scoring tool developed by a UVA Children's pediatrician and his collaborator at the University of Florida -- to identify patients at risk and help them reduce that risk.
"We had previously shown that the severity of metabolic syndrome was linked to future coronary heart disease and type 2 diabetes," said UVA's Mark DeBoer, MD. "This study showed further links to future ischemic strokes."
Ischemic Stroke Risk
DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.
To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)
The researchers used their tool to calculate "Z scores" measuring the severity of metabolic syndrome among the study participants. They could then analyze the association between metabolic syndrome and ischemic stroke risk.
The subgroup with the highest association between metabolic syndrome and risk for ischemic stroke was white women, the researchers found. In this group, the research team was able to identify relationships between the individual contributors to metabolic syndrome, such as high blood pressure, and stroke risk.
The researchers note that race and sex did not seem to make a major difference in stroke risk overall, and they caution that the increased risk seen in white women could be the results of chance alone. "Nevertheless," they write in a new scientific article outlining their findings, "these results are notable enough that they may warrant further study into race and sex differences."
The overall relationship between metabolic syndrome severity and stroke risk was clear, however. And this suggests people with metabolic syndrome can make lifestyle changes to reduce that risk. Losing weight, exercising more, choosing healthy foods -- all can help address metabolic syndrome and its harmful effects.
DeBoer hopes that the tool he and Gurka developed will help doctors guide patients as they seek to reduce their stroke risk and improve their health and well-being.
"In case there are still individuals out there debating whether to start exercising or eating a healthier diet," DeBoer said, "this study provides another wake-up call to motivate us all toward lifestyle changes."
https://www.sciencedaily.com/releases/2020/08/200814101659.htm
Ischemic stroke rates decrease during COVID-19 pandemic
June 9, 2020
Science Daily/Michigan Medicine - University of Michigan
A new research letter reveals fewer people have been admitted to stroke centers in Michigan and northwest Ohio since the onslaught of the COVID-19 pandemic, and significantly fewer patients received a mechanical thrombectomy for their ischemic stroke.
The authors call COVID-19's influence on other critical illnesses like stroke a bystander effect. That's because time is of the essence for patients with stroke, but not everyone is getting to a comprehensive stroke center for needed care right now.
In the letter, researchers from Michigan Medicine with colleagues across the Michigan Stroke Treatment Improvement Collaborative reported a significant reduction in ischemic stroke admissions in March when compared both to February of this year (17.8%) and to March of 2019 . Similarly, rates of a procedure for ischemic stroke, mechanical thrombectomy, significantly declined this March compared to February and compared to March of 2019.
"A combination of patient fears, stringent patient transfer criteria, and health system strains may have contributed to lower ischemic stroke admissions as well as the near disappearance of thrombectomy procedures," the authors write.
The differences were most pointed in ischemic stroke and quantity of thrombectomy procedures, authors say, while there was less of a change compared to past months for hemorrhagic stroke.
https://www.sciencedaily.com/releases/2020/06/200609095025.htm
Stroke rates among COVID-19 patients are low, but cases are more severe
Overall stroke hospital admissions are down globally
May 21, 2020
Science Daily/American Heart Association
The rate of strokes in COVID-19 patients appears relatively low, but a higher proportion of those strokes are presenting in younger people and are often more severe compared to strokes in people who do not have the novel coronavirus, while globally rates for stroke hospitalizations and treatments are significantly lower than for the first part of 2019, according to four separate research papers published this week in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.
In "SARS2-CoV-2 and Stroke in a New York Healthcare System," researchers reported key demographic and clinical characteristics of patients who developed ischemic stroke associated with the COVID-19 infection and received care within one hospital system serving all 5 boroughs of New York City.
During the study period of March 15 through April 19, 2020, out of 3,556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging-proven ischemic stroke. They compared those 32 patients admitted with stroke and COVID-19 to those admitted only with stroke (46 patients) and found that the patients with COVID-19:
tended to be younger, average age of 63 years vs. 70 years for non-COVID stroke patients;
had more severe strokes, average score of 19 vs. 8 on the National Institutes of Health Stroke Scale;
had higher D-dimer levels, 10,000 vs. 525, which can indicate significant blood clotting;
were more likely to be treated with blood thinners, 75% vs. 23.9%;
were more likely to have a cryptogenic stroke in which the cause is unknown, 65.6% vs. 30.4%; and
were more likely to be dead at hospital discharge, 63.6% vs. 9.3%.
Conversely, COVID-19 stroke patients were less likely than those stroke patients without the novel coronavirus to have high blood pressure (56.3% vs. 76.1%) or to have a prior history of stroke (3.1% vs. 13%).
The researchers observed that the rate of imaging-confirmed acute ischemic stroke in hospitalized patients with COVID-19 in their New York City hospital system was lower compared to prior reports in COVID-19 studies from China. One reason for the difference might be related to variations in race/ethnicity between the two study populations. In addition, the low rate of ischemic stroke with COVID-19 infection may be an underestimate because "the diagnosis of ischemic stroke can be challenging in those critically ill with COVID-19 infection who are intubated and sedated," said lead study author Shadi Yaghi, M.D., FAHA, of the department of neurology at NYU Grossman School of Medicine in Manhattan.
Yaghi said, "It was difficult to determine the exact cause of the strokes of the COVID-19 patients, however, most patients appeared to experience abnormal blood clotting. Additional research is needed to determine if therapeutic anticoagulation for stroke is useful in patients with COVID-19." The researchers noted that at least one clinical trial is already underway to investigate the safety and efficacy of treatment for active clotting vs. preventive treatment in certain patients with COVID-19 infection presenting with possible clotting indicators.
Yaghi and his coauthors also noted the number of stroke cases with COVID-19 seems to have peaked and is now decreasing. This finding may be related to the overall reduction in COVID-19 hospital admissions, which may be due to social distancing and guidance for people to stay at home. In addition, the number of stroke patients hospitalized during the study period was significantly lower than the same time frame in 2019.
Similar trends are reported in several other studies also published this week in Stroke, reflecting a global disruption of emergency health care services including delayed care and a lower-than-usual volume of stroke emergencies during the COVID-19 pandemic crisis.
In a Hong Kong study, "Delays in Stroke Onset to Hospital Arrival Time during COVID-19," by lead author Kay Cheong Teo, M.B.B.S., researchers compared the stroke onset time to hospital arrival time for stroke and transient ischemic attack (TIA) patients from Jan. 23 to March 24, 2020 (the first 60 days from the first diagnosed COVID-19 case in Hong Kong) to the same time period in 2019. In 2020, 73 stroke patients presented to Queen Mary Hospital compared to 83 in 2019. However, the time from stroke onset-to-arrival time was about an hour longer in 2020 compared with last year (154 minutes vs. 95 minutes). In addition, the number of patients arriving within the critical 4.5-hour treatment window dropped from 72% in 2019 to 55% in 2020.
Also from China, "The impact of the COVID-19 epidemic on stroke care and potential solutions," by lead author Jing Zhao, M.D., Ph.D., detailed survey results from more than 200 stroke centers through the Big Data Observatory Platform for Stroke of China, which consists of 280 hospitals across China. They found that in February 2020, hospital admissions related to stroke dropped nearly 40%, while clot-busting treatment and mechanical clot-removal cases also decreased by 25%, compared to the same time period in 2019. The researchers cited several factors likely contributed to the reduced admissions and prehospital delays during the COVID-19 pandemic, such as lack of stroke knowledge and proper transportation. They also noted that another key factor was patients not coming to the hospital for fear of virus infection.
In a fourth study, "Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak," by lead author Basile Kerleroux, M.D., researchers in France compared patient data from stroke centers across the country from February 15 through March 30, 2020 to data of patients treated during the same time period in 2019. They found a 21% decrease (844 in 2019 vs. 668 in 2020) in overall volume of ischemic patients receiving mechanical thrombectomy during the pandemic compared to the previous year.
Additionally, there was a significant increase in the amount of time from imaging to treatment overall -- 145 minutes in 2020 compared to 126 minutes in 2019, and that delay increased by nearly 30 minutes in patients transferred to other facilities for treatment after imaging. The researchers said delays may have been due to unprecedented stress on emergency medical system services, as well as primary care stroke centers lacking transfer resources needed to send eligible patients to thrombectomy capable stroke centers within the therapeutic window. They noted stricter applications of guidelines during the pandemic period could also have meant some patients may have not been referred or accepted for mechanical thrombectomy treatment during that time.
https://www.sciencedaily.com/releases/2020/05/200521124648.htm
Eating a vegetarian diet rich in nuts, vegetables, soy linked to lower stroke risk
February 28, 2020
Science Daily/American Academy of Neurology
People who eat a vegetarian diet rich in nuts, vegetables and soy may have a lower risk of stroke than people who eat a diet that includes meat and fish, according to a study published in the February 26, 2020, online issue of Neurology®, the medical journal of the American Academy of Neurology.
"Stroke is the second most common cause of death worldwide and a leading cause of disability," said study author Chin-Lon Lin, M.D., of Tzu Chi University in Hualien, Taiwan. "Stroke can also contribute to dementia. If we could reduce the number of strokes by people making changes to their diets, that would have a major impact on overall public health."
The study involved two groups of people from Buddhist communities in Taiwan where a vegetarian diet is encouraged, and smoking and drinking alcohol are discouraged. Approximately 30% of participants in both groups were vegetarians. Of the vegetarians, 25% were men. Researchers defined vegetarians as people who did not eat any meat or fish.
At the start of the study, the average age of all participants was 50 and none had experienced stroke. The first group of 5,050 people was followed for an average of six years. The second group of 8,302 people was followed for an average of nine years. Participants were given medical exams at the start of the study and asked about their diet.
Vegetarians ate more nuts, vegetables and soy than non-vegetarians and consumed less dairy. Both groups consumed the same amount of eggs and fruit. Vegetarians ate more fiber and plant protein. They also ate less animal protein and fat.
Researchers then looked at a national database to determine the numbers of strokes participants had during the course of the study.
In the first group of 5,050 people, there were 54 strokes. For ischemic strokes, which are strokes when blood flow to part of the brain is blocked, there were three strokes among 1,424 vegetarians, or 0.21%, compared to 28 strokes among 3,626 non-vegetarians, or 0.77%. After adjusting for age, sex, smoking and health conditions like high blood pressure and diabetes, researchers found vegetarians in this group had a 74% lower risk of ischemic stroke than non-vegetarians.
In the second group of 8,302 people, there were 121 strokes. For both ischemic and hemorrhagic strokes, also called bleeding strokes, there were 24 strokes among 2,719 vegetarians, or 0.88%, compared to 97 strokes among 5,583 non-vegetarians, or 1.73%. After adjusting for other factors, researchers found vegetarians in this group had a 48% lower risk of overall stroke than non-vegetarians, a 60% lower risk of ischemic stroke and a 65% lower risk of hemorrhagic stroke.
"Overall, our study found that a vegetarian diet was beneficial and reduced the risk of ischemic stroke even after adjusting for known risk factors like blood pressure, blood glucose levels and fats in the blood," said Lin. "This could mean that perhaps there is some other protective mechanism that may protecting those who eat a vegetarian diet from stroke."
One limitation of the study was that the diet of participants was only assessed at the start of the study, so it is not known if participants' diets changed over time. Another limitation was that study participants did not drink or smoke, so results may not reflect the general population. Also, results from the study population in Taiwan may not be generalizable worldwide. Finally, there could be other factors, not accounted for, that might affect stroke risk.
https://www.sciencedaily.com/releases/2020/02/200228102225.htm