Welcome to the ESOC 2021 Virtual Conference Calendar
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Introduction by the Convenors
COMPLEX INTERACTIONS BETWEEN OBESITY AND WHITE MATTER: UK BIOBANK STUDY
Abstract
Background And Aims
Small vessel disease (SVD) is most strongly associated with ageing and hypertension, but the interaction with other modifiable risk factors such as obesity is unclear. This study investigated the effect of obesity on the extent of white matter hyperintensities of vascular origin (WMH) and its interaction with raised blood pressure.
Methods
UK Biobank is a prospective community-based cohort of 502,484 40-69-year-old people, with brain magnetic resonance imaging data available for 45,877 of them. Linear models were used to investigate associations between WMH load (normalised logit-transformed WMH volume) and concurrent mean blood pressure (MAP), pulse pressure (PP), and body mass index (BMI), adjusted for age, sex, diabetes, and smoking.
Results
In fully-adjusted models, BMI was associated with higher WMH load independently of age, high blood pressure, and other cardiovascular risk factors: standardised beta-coefficient for BMI: beta=0.067 95%CI 0.053 to 0.080; PP beta=0.049 95%CIs 0.033 to 0.064; MAP (beta=0.080 95%CIs 0.066 to 0.094 (Figure). Female gender was protective against the negative effects of BMI on WMH compared to male gender, with male gender particularly detrimental in mid-life. Visceral obesity was linked with higher WMH load, beyond the effect of BMI and vascular risk factors.
Conclusions
Obesity is an independent risk factor in the development and progression of white matter hyperintensities, especially in men in midlife. Although the relationships between obesity, blood pressure and WMH are complex, control of BMI may be just as important as good blood pressure control, especially in middle-aged men.
Trial Registration Number
Not applicable.
CEREBRAL AUTOREGULATION MAY MEDIATE THE ASSOCIATION BETWEEN AUTONOMIC DYSFUNCTION AND CEREBROVASCULAR AGEING
Abstract
Background And Aims
Impaired cerebral autoregulation (CA) is a potential treatment target to prevent stroke but a possible causative relationship with vascular ageing is unclear. We determined the association between markers of CA with autonomic dysfunction and arterial stiffness, and the effect of age.
Methods
438 patients with TIA and non-disabling stroke were recruited from the Oxford Vascular Study. Continuous ECG, blood pressure (BP), and bilateral transcranial Doppler ultrasound monitoring of middle cerebral artery flow velocity were measured simultaneously for at least 5-minutes. Transfer function analyses were performed to estimate CA (gain, phase, and coherence) and baroreceptor sensitivity (BRS) in low-frequency (LF, 0.07–0.15Hz) and high-frequency [HF, 0.15–0.4Hz]) bands. BP variability (BPV; coefficient of variations), power spectral density (PSD) and complexity (modified multiscale entropy) were derived. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWV). Partial correlations were calculated to estimate the associations between derived indices or age, un-adjusted and adjusted for age, gender, hypertension, and diabetes.
Results
CA-gain-LF was correlated with BRS-LF and HF, and BP-complexity, and negatively associated with BPV and PSD-LF (p <0.001). Coherence-LF was associated with BRS in HF and BP-complexity, and negatively associated with PWV (all p<0.05 after adjustment). BRS, BP-complexity, and PWV were strongly correlated with age, whilst CA gain and coherence were inversely associated with age (all p<0.05).
Conclusions
CA-gain and coherence in LF fell with autonomic dysfunction and vascular ageing and were inversely correlated with age, suggesting CA as a potentially treatable cerebral manifestation of vascular ageing.
Trial Registration Number
Not applicable
SOCIAL INEQUALITY IN THE RISK OF CANCER IN THE DANISH STROKE POPULATION 2003-2015 THE IMPACT OF INCOME AND EDUCATION
Abstract
Background And Aims
Cancer is common in stroke (>10%). Cancer and stroke both relate to social position in society. The role of social position in stroke patients' risk of cancer has, however, not been studied. We investigated social position expressed by income and length of education and stroke patients' risk of being diagnosed with cancer.
Methods
All patients >40 years of age with first-ever stroke in Denmark 2003-2015 were identified in the Danish Stroke Register (n=85,893) and matched 1:10 on age and sex with the Danish background population without stroke (n=858,740). Information on Charlson co-morbidity, income, education, marital status, ethnicity and cancer diagnosed in the first year after stroke/index date in both cohorts was obtained from nationwide registries. Cox regression models were used to estimate stroke patients' risk of cancer compared to the background population.
Results
In the stroke/background population 2018/15152 patients were diagnosed with cancer. Stroke patients' risk of cancer was confined only to smoking-related cancers (e.g. lung, colon, kidney) (HR 1.64;CI 1.53-1.75). Risk was not increased for non-smoking related cancers (e.g. prostate, breast, malignant melanoma) (HR 1.09;CI 0.99-1.20). For smoking-related cancers risk increased significantly with lower education and income. For non-smoking related cancers the association with social position was reverse.
Conclusions
Stroke patients' cancer risk was socially biased, however, in a bidirectional way. Low social position associated with higher risk of smoking-related cancers while at the same time also being associated with lower risk of non-smoking related cancers The opposite was the case for patients with high social position.
10-YEAR TRENDS IN CARDIOVASCULAR RISK FACTORS IN SWITZERLAND: NON-TRADITIONAL RISK FACTORS ARE ON THE RISE IN WOMEN MORE THAN IN MEN
Abstract
Background And Aims
Effective control of cardiovascular risk factors is the prerequisite to prevent stroke and other cardiovascular diseases. Diabetes, arterial hypertension, dyslipidemia, smoking, obesity and physical inactivity are recognized modifiable traditional risk factors (cvRF). However, recently, non-traditional risk factors (nt-cvRF) have been discovered to significantly add to cardiovascular risk. Notably, the importance of cardiovascular risk factors including nt-cvRF varies with sex. Our goal was to assess 10-year trends in cardiovascular risk factors in Switzerland and to reveal sex differences.
Methods
Data were derived from the governmental Swiss Health Survey, which is performed every five years. We analyzed anonymized data from 2007, 2012 and 2017 in a cross-sectional approach. Epidemiological parameters, cvRF and nt-cvRF were compared between men and women.
Results
Data of 22134 participants were available (51% women). The percentage of women with full-time jobs increased significantly from 2007/2012/2017: 39%/39%/44%. Some cvRFs were reported with stable frequency over the observation period (hypertension: 27%, diabetes 5%, dyslipidemia 18%), while obesity increased, and smoking decreased. Overweight and smoking were more prevalent in men compared to women. However, there was an overall increase in nt-cvRF (2007/2012/2017): stress at work (not available (NA) /59%/ 67%), reduced feeling of energy and vitality (NA/23%/29%), sleep disorders (26%/24%/29%), which was more accentuated in women.
Conclusions
We found an overall increase in nt-cvRFs, which were more pronounced in female participants, while most cvRFs remained stable. These results underscore the fact that sex differences exist for nt-cvRF, with an alarming trend towards a particular increase in women.
Trial Registration Number
"Not applicable"
ARE THERE SEX DIFFERENCES IN THE ASSOCIATION BETWEEN STROKE RISK FACTORS AND CAROTID PLAQUES, INTIMA-MEDIA THICKNESS OR DISTENSIBILITY IN ADULTS?
Abstract
Background And Aims
The association between some cardiovascular (CV) risk factors and stroke differs between men and women. We explored sex differences in the association between blood pressure (BP), metabolic markers and smoking in early adulthood with carotid plaques, intima-media thickness (IMT) and distensibility (CD) in mid-adulthood.
Methods
Participants in the Childhood Determinants of Adult Health study at ages 26-36 years were followed-up at ages 39-49 years. Questionnaires measured smoking, while metabolic markers (fasting glucose, insulin, and insulin resistance), systolic BP and diastolic BP and carotid ultrasound measures (plaques, IMT and CD) were performed in clinics. We used log binomial and linear regression models with risk factor * gender interactions for predicting these carotid measures. Sex-stratified models adjusted for sociodemographic factors were fitted when likelihood ratio tests suggested the effect of risk factors on outcomes differed by sex.
Results
Among 1,286 participants (53% women), men, compared to women, had higher prevalence of carotid plaques (17% vs. 10%), thicker carotid IMT (Mean 0.66 ± 0.09 vs. 0.61 ± 0.07) and lower CD (Mean 1.87 ± 0.60 vs. 2.37 ± 0.77). In women but not men, current smoking, greater systolic BP and higher glucose level were associated with significantly greater risk of plaques (Figure 1a) and smaller CD (Figure 1b & 1c).
Conclusions
CV health was worse in men than women. However, the presence of risk factors such as smoking, elevated systolic BP and glucose in women put them at greater risk of poorer CV health compared to men.
CHARACTERISTICS OF ISCHEMIC WAKE-UP STROKE AND UNKOWN-ONSET STROKE IN THE NATIONWIDE NORWEGIAN STROKE REGISTER
Abstract
Background And Aims
Previous studies indicate that patients with wake-up stroke (WUS) are similar to patients with known onset stroke (KOS), but may differ from patients with unknown-onset stroke (UOS). We compared risk factors and clinical characteristics in patients with ischemic WUS, UOS, and KOS from a large national stroke register.
Methods
We included patients registered in the Norwegian Stroke Register from 2012 to 2019. Information on age, gender, risk factors, medication use and clinical characteristics were compared between patients with ischemic WUS, UOS and KOS.
Results
Of the 52 134 ischemic strokes, 19.8 % were WUS and 17.7% UOS. Patients with UOS were older (76.6 years, SD 12.6) than patients with WUS (73.6, SD 13.0) and KOS (73.5, SD 13.3). A higher proportion were women (50.3% vs. 43.0% in WUS and 44.8% in KOS) and lived alone (52.5% in the OUS group vs. 36.6% in both WUS and KOS groups). After adjustment for age and sex, atrial fibrillation was more frequent among UOS patients. Other cerebrovascular risk factors did not substantially differ between groups. WUS patients had milder strokes compared to UOS and KOS, while more UOS patients had NIHSS > 15 and a reduced level of consciousness on admission.
Conclusions
WUS patients shared baseline characteristics with KOS, but tended to have milder strokes. UOS patients were older and larger proportions were women, lived alone, had atrial fibrillation and severe strokes compared to WUS and KOS patients. The results indicate that WUS and UOS should be considered separate entities in future research.
Trial Registration Number
Not applicable
CAROTID PLAQUE COMPOSITION AND PREDICTION OF STROKE
Abstract
Background And Aims
We determined the incremental value of carotid plaque components – beyond traditional cardiovascular risk factors – for predicting first-ever stroke events.
Methods
Between 2007 and 2012, participants from the population-based Rotterdam Study with asymptomatic carotid wall thickening >2.5 mm on ultrasonography, were invited for carotid MRI. Among 1349 participants (mean age: 72 years, 49.5% women) without cardiovascular disease, we assessed plaque thickness, carotid stenosis(>30%), presence of intraplaque hemorrhage, lipid-rich necrotic core, and calcification. Follow-up for stroke was complete until January 1, 2016. Using Cox proportional hazards regression we fitted prediction models including traditional cardiovascular risk factors (base model), and calculated 5-year predicted risks of stroke. We extended the base models by single and simultaneous additions of plaque characteristics, and calculated the c-statistics.
Results
During a median follow-up time of 5.6 years, 56 strokes occurred. The median predicted 5-year risk of stroke based on traditional cardiovascular risk factors was 3.3%. Intraplaque hemorrhage and carotid stenosis were associated with incident stroke (adjusted HR intraplaque hemorrhage: 2.04, 95%CI=1.17-3.53, stenosis: 1.80, 95%-CI=1.00-3.24). After simultaneous addition of all plaque components, plaque thickness, and carotid stenosis to the base model, only intraplaque hemorrhage remained statistically significantly associated with incident stroke. The c-statistic (95%CI) improved from 0.67 (0.60-0.73) to 0.69 (0.62-0.75) after single addition of intraplaque hemorrhage to the base model. Other plaque characteristics did not improve the model discriminative ability for predicting first-ever stroke beyond traditional risk factors.
Conclusions
Presence of intraplaque hemorrhage is a predictor of first-ever stroke, independent of traditional cardiovascular risk factors, and other plaque characteristics.
Trial Registration Number
Not applicable