Displaying One Session

e-Poster Discussion
Session Type
e-Poster Discussion
Room
Station 3 (E-Poster Area)
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM

HEALTHY AGEING THROUGH INTERNET COUNCELLING IN THE ELDERLY (HATICE) - A MULTINATIONAL RANDOMISED CONTROLLED TRIAL ON CARDIOVASCULAR RISK REDUCTION

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:30 PM - 06:35 PM

Abstract

Group Name

HATICE consortium

Background And Aims

The HATICE trial investigated whether a coach-supported Internet intervention for self-management can reduce cardiovascular risk in community-dwelling older persons.

Methods

This prospective open-label blinded endpoint (PROBE) clinical trial among people 65 years or over at increased risk of cardiovascular disease (CVD) randomized participants in the Netherlands, Finland and France to an interactive Internet intervention stimulating coach-supported self-management or a control platform. Primary outcome was the difference from baseline to 18 months on a standardized composite score (z-score) of systolic blood pressure (SBP), LDL cholesterol, and body mass index (BMI). Secondary outcomes included individual risk factors and cardiovascular endpoints including stroke. ISRCTN 48151589.

Results

2724 Participants were included. After 18 months the primary outcome improved 0·09 in the intervention group vs. 0·04 in the control group (Mean Difference (MD) -0·05;95%CI -0·01to -0·08, p=0·008). For individual risk factors, MDs (intervention vs. control) were: SBP -1·79 vs. -0·67 mmHg (MD -1·12,95%CI -2·51 to 0·27); LDL -0·12 vs. -0·07 mmol/l (MD -0·05,95%CI -0·11-to 0·01); BMI -0·23 vs. -0·08 kg/m2 (MD -0·15,95%CI -0·28 to -0·01). In those with low education the intervention was more effective (MD -0.11,95%CI -0.18 to -0.04) and the effect on SBP was largest (MD -3.25mmHg,95%CI -6.00 to -0.51). Stroke occurred in 13/1335 (1.0%) vs. 4/1383 (0.3%), HR 0.3, 95%CI 0.10-0.93).

Conclusions

Coach-supported self-management of cardiovascular risk factors using an interactive Internet intervention in older persons leads to a modest, significant improvement of cardiovascular risk profile. When implemented on a large scale this could potentially reduce the burden of CVD.

Trial Registration Number

ISRCTN 48151589

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DO EUROPEAN PATIENTS WITH CEREBROVASCULAR DISEASE RECEIVE OPTIMAL LIPID LOWERING THERAPY AND ACHIEVE LDL-C GOALS? RESULTS FROM THE DA VINCI STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:35 PM - 06:40 PM

Abstract

Background And Aims

Describe lipid lowering therapy (LLT) and achievement of LDL-C goals in EAS/ESC dyslipidaemia guidelines among patients with cerebrovascular disease.

Methods

Cross-sectional study in consenting adults with LLT in the past 12 months and LDL-C measurement(s) in the past 14 months, seen in primary or secondary care across 18 European countries. Patients with coronary, peripheral and cerebral disease were enrolled at a ratio of 1:2:2 (FH patients with prior cardiovascular events excluded). Data were collected from medical records at a single visit between Jun ‘17–Nov ’18, including LLT and most recent LDL-C. Primary outcome was LDL-C goal attainment ≥ 28 days after starting most recent LLT (treatment-stabilised LLT). We report data from patients with cerebrovascular disease.

Results

Of 5888 patients enrolled, 2794 met our definition of atherosclerotic cardiovascular disease (ASCVD). Primary vascular bed was cerebral in 1136 (41%) patients (coronary, 622 [22%]; peripheral, 1036 [37%]). The majority of patients with cerebrovascular disease had prior ischemic stroke (895 [79%]) or transient ischemic attack (215 [20%]). 47% (534/1136) of patients with cerebrovascular disease were receiving low/moderate intensity statins and 46% (527/1136) receiving high intensity statins; 751 had a treatment-stabilised LDL-C (median, 79 mg/dL), of whom 36% (268/751) achieved the 2016 EAS/ESC LDL-C target goal of <70 mg/dL and 16% (122/751) achieved the 2019 target goal of <55 mg/dL.

Conclusions

European patients with cerebrovascular disease are not treated as per EAS/ESC recommendations; a large proportion received suboptimal LLT and only 16% to 36% achieved target LDL-C levels.

Trial Registration Number

DRKS00012884

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ASSOCIATION OF SYSTOLIC BLOOD PRESSURE LEVEL AND ITS VISIT-TO-VISIT VARIABILITY WITH ISCHEMIC/BLEEDING EVENTS DURING LONG-TERM MEDICATION WITH PRASUGREL OR CLOPIDOGREL AFTER NON-CARDIOEMBOLIC STROKE: PRASTRO-I

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:40 PM - 06:45 PM

Abstract

Group Name

PRASTRO Trial Investigators

Background And Aims

High blood pressure (BP) increases the bleeding risk during antithrombotic medication. The association of BP levels during long-term secondary stroke prevention with thienopyridines, in particular prasugrel, with the risk of ischemic/bleeding events has been understudied.

Methods

This was a post-hoc analysis of the multicenter, randomized, double-blind PRASTRO-I trial (JapicCTI-111582). Patients with non-cardioembolic stroke were randomly assigned (1:1) to receive prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96-104 weeks. Risks of ischemic (ischemic stroke, myocardial infarction, and vascular death) and bleeding (life-threatening or major) events, as well as that of ischemic stroke and intracerebral hemorrhage, were determined according to the mean level and successive variation (SV) of systolic BP (SBP) throughout the observational period. The risks were also compared among quartiles of mean levels and SV of SBP.

Results

A total of 3747 patients (62.1±8.5 years old, 797 women) were studied. All the risks of the ischemic events (142 events), bleeding events (47 events), ischemic stroke (133 events) and intracerebral hemorrhage (13 events) were positively correlated with increasing mean SBP overall (p=0.029, 0.004, 0.039, <0.001, respectively). There was no difference in any event rate between two treatment groups at each quartile. Similarly, all the risks of these events were positively correlated with increasing SV of SBP overall (p<0.001 for all) with no significant differences between treatment groups at each quartile.

Conclusions

Both the mean level and the visit-to-visit variability of SBP are predictive of ischemic and bleeding event risks during long-term medication with either prasugrel or clopidogrel after stroke.

Trial Registration Number

JapicCTI-111582

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THE IMPACT OF LIFESTYLE AND CARDIOVASCULAR RISK FACTORS ON EARLY ATHEROSCLEROSIS IN ADOLESCENTS

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:45 PM - 06:50 PM

Abstract

Group Name

The Early Vascular Ageing (EVA) Study Group

Background And Aims

As the formation of atherosclerosis initiates early in life, our aim was to assess the association of lifestyle and cardiovascular risk factors with the intima-media thickness, a surrogate for early vascular aging, in healthy adolescents.

Methods

1573 adolescents with a mean age of 16 years were enrolled, 1000 of which received a prospective follow-up after an average of 22.1 months. Cardiovascular risk and lifestyle factors were evaluated by standardized interviews, physical examination, and fasting blood analyses. Carotid intima-media thickness (cIMT) was measured at baseline and follow-up by high-resolution ultrasound. Aortic intima-media thickness (aIMT) was assessed during follow-up only.

Results

Several vascular risk factors like elevated blood pressure (4.7% >95th percentile), overweight (9.2% >95th percentile) and smoking (29.7%) were already prevalent at this age. In multivariable linear regression analysis male sex, body weight, systolic blood pressure, LDL-cholesterol and physical activity were independent predictors of cIMT both at baseline and follow-up. In addition, alanine-aminotransferase, a laboratory surrogate of non-alcoholic fatty liver disease, was independently associated with cIMT at follow-up and pack-years of smoking with aIMT. Variability of cIMT in general was low in this age group and no plaque formations were observed. cIMT showed a slow progression of 3.5 µm/year (95% CI, 1.1-5.9).

Conclusions

Unfavorable lifestyle and cardiovascular risk factors were prevalent in adolescents and already showed an association with vessel wall thickness. Hence, interventional strategies in early life might be successful in preventing cardiovascular manifestations in later life.

Trial Registration Number

NCT03929692

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ACCREDITED SOCIAL HEALTH ACTIVIST FOR VASCULAR RISK FACTOR CONTROL IN RURAL STROKE PATIENTS (ASSIST) STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:50 PM - 06:55 PM

Abstract

Background And Aims

Vascular risk factor control in stroke patients is important to prevent recurrent major cardiovascular and cerebrovascular events. In the rural population, this is hindered by the lack of physicians and nurses. We hypothesized, accredited social health activists (ASHA) a community health worker can help lower blood pressure (BP) in stroke patients at the end of 6 months.

Methods

In this cluster randomised trial two rural blocks with 70 and 94 villages respectively, stroke patients were assigned to either ASHA assisted risk factor control with standard treatment (ST) and ST alone. Assessors blinded to intervention conducted the baseline visit and 6 months follow up visits in both the rural blocks. In the intervention arm, ASHA conducted weekly visits for the first month and monthly visits for the remaining 5 months.

Results

A total of 140 patients with a mean age of 63.7±11.5 years and 44.3% of females were randomised. The baseline systolic BP was higher in the intervention arm (n=65) compared to ST arm (n=75) was 173.5±22.9 mmHg and 163±18.7 mmHg respectively (p=0.004). The follow-up systolic BP was lower in the intervention arm compared to ST arm 145±17.2 mmHg and 166.6±25.7 mmHg respectively (p<0.0001). The follow-up median (IQR) blood glucose levels, 109 (98, 130) mg% vs. 129 (104, 198) mg%, p=0.009 were lower and patients with regular exercise percentage increased by 26.5% vs -2% in the intervention arm.

Conclusions

Task sharing by ASHAs can improve BP control in rural populations with stroke. Community health workers can also help in the adoption of healthy behavior.

Trial Registration Number

Clinical Trial Registration Number: ctri.nic.in, CTRI/2018/09/015709

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IMPACT OF PHYSICAL ACTIVITY IN VASCULAR COGNITIVE IMPAIRMENT - THE AFIVASC STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
06:55 PM - 07:00 PM

Abstract

Group Name

AFIVASC Study Group

Background And Aims

Vascular cognitive impairment (VCI) is associated with cognitive, mood, urinary and gait changes. We conducted a randomized controlled trial to evaluate the impact of physical activity on cognition (primary outcome), quality of life, motor performance and functional status (secondary outcomes) in patients with mild VCI.

Methods

A hundred and four patients (mean age 71.2 years-old; 53 women) with mild VCI were randomized for a six-month intervention (n=53) with moderate physical activity (60 minute sessions 3 times/week) or best practice usual care (n=51), stratified by sex. Neuropsychological, functional, mood and motor performance including accelerometry were evaluated at inclusion and month-6. Attendance of sessions (for the intervention group) was recorded.

Results

For the primary outcome, no cognitive decline was observed in the intervention and best usual care groups after 6-months, as well as in quality of life and functional status. The intervention group improved significantly after 6 months in aerobic capacity (6 minutes walking test) and in agility (8-foot up and go). Attendance of the sessions was variable (18/45,40% attended less than half of the sessions). In the intervention group, MoCA score at 6 months improved in those who fulfilled WHO recommendations for physical activity (23.2 at baseline to 24.7 at month-6, p<0.01).

Conclusions

Cognitive improvement was observed among subjects in the intervention group fulfilling physical activity WHO recommendations, irrespectively of attendance rate of the sessions. The whole sample had no significant cognitive decline over 6 months. Intervention over 6 months had a beneficial impact in aerobic capacity and agility.

Trial Registration Number

Trial Registration: ClinicalTrials.gov Identifier (NCT03578614)

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IMPACT OF ADHERENCE TO ANTIPLATELET MEDICATION ON LONG-TERM CARDIOVASCULAR OUTCOMES AND ALL-CAUSE MORTALITY AFTER ISCHEMIC STROKE: A NATIONWIDE COHORT STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
07:00 PM - 07:05 PM

Abstract

Background And Aims

Numerous trials have proved antiplatelet therapy as a foundation of prevention of vascular death, myocardial infraction (MI) and stroke recurrence in patients with prior history of ischemic stroke. Nevertheless, non-adherence to antiplatelet medications is known to be pandemic and is associated with poor clinical outcomes. The aim of this study was to examine the effect of adherence to antiplatelet medications on the major cardiovascular outcomes and all-cause mortality for patients with newly diagnosed ischemic stroke in a real-world setting by using a large-scale representative national claims data of Korea.

Methods

We included 2210 Patients who were newly treated ischemic stroke with antiplatelet therapy during 2003 to 2010. Adherence to antiplatelet medications were measured using the Medication Possession Ratio (MPR) according to the pharmacy claims data. The main outcome of this study was a composite endpoint of recurrent ischemic stroke, myocardial infarction (MI) or all-cause mortality. Time-dependent Cox proportional hazard regression analyses were performed.

Results

During the mean follow-up period of 6.45 years, 450 patients had the primary outcome. The proportion of patients with good adherence to antiplatelet medication was 69.05%. Compared with good adherence, the adjusted hazard ratio (95% confidence interval) for the primary outcome was 1.55 (1.29–1.87) for poor adherence group.

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Conclusions

A good adherence to antiplatelet therapy is associated with good clinical outcome and thus important with ischemic infarction patients. Follow-up studies on factors affecting compliance are needed.

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PREDICTORS OF LONG-TERM MORTALITY IN SPONTANEOUS INTRACEREBRAL HAEMORRHAGE SURVIVORS.

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
07:05 PM - 07:10 PM
Presenter

Abstract

Background And Aims

Factors associated with long-term mortality after spontaneous intracerebral haemorrhage (ICH) have been poorly investigated. Our objective was to identify predictors of long-term mortality in a prospective cohort of 30-day survivors of spontaneous ICH.

Methods

We prospectively included consecutive adults admitted between 2004 and 2009 within the first 24 hours of a spontaneous ICH, who survived at least 30 days. We evaluated clinical and radiological predictors of long-term mortality using univariate and multivariable Cox’ proportional hazard regression models.

Results

Of 560 patients with spontaneous ICH, 304 (64%) survived more than 30 days and consented for the follow-up. During a median follow-up of 10 years (interquartile range [IQR] 8.0-10.5), 176 (58%) patients died, leading to a median survival of 6.8 (IQR 6.0-7.8) years after ICH. Age (hazard ratio [HR] per 10-year increase: 1.63; 95% confidence interval (CI): 1.42-1.87), national institutes of health stroke scale score at admission (HR per 1-point increase: 1.03; CI: 1.01-1.04), baseline ICH volume higher than 30 ml (HR: 1.62; CI: 1.10-2.38), on-going antiplatelet therapy before ICH (HR: 1.45; CI: 1.06-1.99) and pre-stroke mRS >2 (HR: 1.72; CI: 1.20 to 2.43) were independent predictors of long-term mortality. In the subgroup of 239 patients who underwent a magnetic resonance imaging (MRI)-scan, cerebral atrophy (HR per 1-point increase: 1.48; CI: 1.11-1.97) was also independently associated with long-term mortality.

Conclusions

Characteristics related to both the ICH and pre-existing status influence long-term mortality. Cerebral atrophy was the only MRI marker independently associated with long-term mortality.

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EVALUATION OF THE USE OF INTERMITTENT ECG RECORDINGS IN ISCHEMIC STROKE AND TRANSIENT ISCHEMIC ATTACK PATIENTS FOR DETECTION OF PAROXYSMAL ATRIAL FIBRILLATION

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
07:10 PM - 07:15 PM

Abstract

Background And Aims

Background

Atrial fibrillation (AF) is considered the strongest risk factor for ischemic stroke but efficient treatment can lower this risk significantly. To detect and treat atrial fibrillation is therefore a very important task within stroke care to reach optimal secondary prevention. The aim of this study was to evaluate the implementation of Zenicor handheld ECG to increase detection of atrial fibrillation in stroke patients.

Methods

Method

We retrospectively investigated patients who were diagnosed with ischemic stroke or TIA submitted from two stroke units in Sweden that were subject to evaluation with Zenicor handheld ECG. Patients who underwent standard care workup including 24h ECG without identifying any apparent cause of stroke were subject to investigation. Patients conducted four ECG recording daily for 14 days.

Results

Results

The investigated population had a mean age of 71, a mean CHADS-VASC of 4,4 and 40% of the patients were of female gender. There were 166 (69%) patients treated for stroke and 75 (31%) treated for TIA. The mean number of recordings per patient was 53. A total number of 241 patients were included and 16 (6,6%) patients were diagnosed with paroxysmal atrial fibrillation. All patients diagnosed with AF received anticoagulation.

Conclusions

Conclusion

A considerable proportion of patients who were admitted for ischemic stroke suffered from paroxysmal atrial fibrillation that remained undetected with standard 24 h ECG investigation. Additional ECG recordings for 14 days increased the detection rate and improved secondary prevention with oral anticoagulation in this material.

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REAL-WORLD STUDY OF LOW-DENSITY LIPOPROTEIN CHOLESTEROL LEVEL AND STATIN THERAPY IN CHINESE PATIENTS WITH ACUTE ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 3 (E-Poster Area)
Lecture Time
07:15 PM - 07:20 PM
Presenter

Abstract

Group Name

The Third China National Stroke Registry (CNSR-III) Group

Background And Aims

The measurement of low-density lipoprotein cholesterol (LDL-c) is routinely used for ischemic stroke (IS) risk assessment and risk management. The use of intensive lipid-lowering therapy by means of statin medications is recommended after IS of atherosclerotic origin. We aim to assess baseline LDL level and usage rates of statins in patients after acute IS in China.

Methods

CNSR-III is a large-scale nationwide registry in China. Between August 2015 and March 2018, the CNSR-III recruited consecutive patients with ischemic stroke or TIA from 201 hospitals that cover 22 provinces and four municipalities in China. Clinical data were collected prospectively using an electronic data capture system by face-to-face interviews. Blood samples were collected and LDL level were tested at baseline. Patients were followed for clinical outcomes and medication information at 3 months, 6 months and 1–5 year annually. Intensive lipid lowering treatment (LLT) was defined as Atorvastatin ≥40mg or Rosuvastatin ≥20mg.

Results

Among 15,166 stroke patients enrolled in CNSR-III (31.7% women, average age of 62.2±11.3 years), the median level of circulating LDL was 2.85±0.90mmol/L. Numbers of patients with baseline LDL ≤1mmol/L , 1mmol/L<LDL≤1.8mmol/L, 1.8mmol/L<LDL≤2.6mmol/L, 2.6mmol/L<LDL≤3.37mmol/L, LDL >3.37mmol/L were 261(2.00%),1342(10.28%),3814(29.21%), 4344(33.26%), 3298(25.25%), respectively. The usage rate of intensive-LLT was 24.63% during hospitalization and was lowered to 4.1% at 3 months after stroke onset. Neither baseline LDL ≤40mg/dl (P=0.76) nor continuing intensive LLT (P=0.74) was associated with hemorrhage events during 3-months follow up.

Conclusions

A large proportion of patients with IS needs to receive LLT in China. Usage rate of intensive LLT remains a challenge, especially after discharge.

Trial Registration Number

Not applicable

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