Welcome to the WSC 2022 Interactive Program

Background and Aims

To establish the frequency of the most significant risk factors for the development of stroke in Uzbekistan and develop a system for improving stroke prevention

Methods

To achieve the goal, we used RES-Q. RES-Q is a Registry of Stroke Care Quality. Developed as an ESO East initiative.

Results

According to the results of our study, hypertension was the most common of all studied risk factors for stroke and was detected in 81.1% of patients. The second risk factor in terms of frequency of occurrence was heredity in 62.3% of patients. There is evidence that family members of stroke patients are more likely to have strokes, myocardial infarctions, and sudden deaths. In our study, patients with cardiovascular pathologies in the form of atrial fibrillation and a history of myocardial infarction occurred in 11.2% and 5.4% of cases, respectively.In our study, in patients with stroke, overweight was detected in 29.2% of patients. Smoking - this indicator according to the results of our study amounted to 19.8% Alcohol accelerates the development of MI by 4.7 times. This indicator according to the results of our study amounted to 12.4% Diabetes mellitus - according to the results of our study amounted to 9.7% Atherosclerosis increases the risk of stroke by 4.0 times.In our studies, this factor was identified in 4.8% of patients.

Conclusions

Thus, the following factors were identified as the main risk factors for strokes (as the strength of influence decreases): arterial hypertension, aggravated heredity, obesity, smoking, alcohol consumption, atrial fibrillation, diabetes mellitus, myocardial infarction and atherosclerosis

Background and Aims

Ischaemic stroke to differentiate risk factors of large vessel occlusion (LVO) and small vessel occlusion (SVO) are interesting to find out due to the high rate of mortality for LVO at 26.2% respectively. We compared LVO and SVO with the risk factors to identify the difference between LVO and SVO.

Methods

We retrospectively reviewed ischemic stroke patients admitted between January 2021 to June 2022 which fulfilled the inclusion criteria from Stroke Registry at the National Brain Centre Hospital, East Jakarta, Indonesia. Patients with LVO and SVO derived from cerebral angiography were analyzed with the risk factors of stroke. Statistical analyses were carried out with STATA 17.0.

Results

A total of 135 were enrolled in this study. Among them, majority of the patient was male 85 (80.19%) with an average age of 58.15±11.05 in LVO, and 24 (82.76%) with an average age of 56.41±13.66 in SVO. The most risk factors in LVO and SVO, consecutively were diabetes mellitus, hypertension, smoking, atrial fibrillation, dyslipidemia, and hyperuricemia. The association between risk factors in LVO and SVO was not significantly different in statistics, except for diabetes mellitus (OR 2.29; 95%CI 0.90-6.05; p-value 0.05).

Conclusions

Risk factors between LVO and SVO were relatively similar, except for diabetes mellitus which have a greater risk for LVO. Further studies with a large amount of samples between LVO and SVO are needed for significant results.

Background and Aims

P Wave Terminal Force in V1 (PTFV1) is an electrocardiogram marker of left atrial abnormality that is associated with higher incidence of cryptogenic and cardio- embolic strokes. It is a good predictor of stroke even in the absence of atrial fibrillation and a strong predictor of paroxysmal atrial fibrillation detection in acute ischemic strokes. This study determined the association between P Wave Terminal Force in Lead V1 (PTFV1) and large artery infarcts among ischemic stroke patients admitted in a tertiary hospital from July 2019 to June 2020.

Methods

Data were obtained from the medical records section. All patients from the database with final diagnosis of Cerebrovascular Disease – Ischemic Stroke were searched and charts were retrieved. A copy of the electrocardiograms (ECGs) were printed and PTFV1s were manually measured using an ECG medical caliper. Cranial computed tomography (CT) scans of patients were reviewed and infarct size was noted. Patients with available 2D Echocardiogram results were assessed for identification of possible cardiac source of emboli.

Results

214 patients were analyzed in this study. 45 (21%) have PTFV1. Age, hypertension, dyslipidemia and history of alcohol use are risk factors identified to be associated with PTFV1. Most of the patients with large infarcts (71.1%; p <0.001) and cardio-embolic stroke have PTFV1 (76.5%; p <0.001).

Conclusions

PTFV1 on electrocardiogram is associated with large artery infarcts and cardio-embolic stroke. Further studies may be needed to elucidate if the presence of PTFV1 can be used as a surrogate risk factor for cardio-embolic stroke in the absence of documented atrial fibrillation.

Background and Aims

A patent foramen ovale (PFO) is prevalent in patients with cryptogenic stroke. Without alternative explanations, it is frequently considered to be causative. The aim of this study is to determine the frequency of PFO in young adults with cryptogenic strokes

Methods

Patients between 18 and 45 years old who presented with an ischemic stroke from April 2020 to August 2020 were included. The type of stroke was classified according the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite cardioembolism, large artery atherosclerosis, or small artery disease despite a standard vascular, cardiac, and serologic evaluation. A PFO diagnosis was identified by the presence of a positive bubble contrast study with transcranial Doppler

Results

Of 142 young patients who presented with ischemic stroke (mean age 38.7±5.6), 26.1% of stroke due to large-artery atherosclerosis, 13.4% of stroke due to cardioembolism, 28.2% of stroke due to small-vessel occlusion, 2.1% stroke of other determined etiologies (artery dissection and hypercoagulative states), cryptogenic strokes account for 30.3%. PFO was identified in 29.6% of patients. PFO was more commonly observed in cryptogenic stroke patients (n=43) than in determined etiology strokes (n=99); (41.9% versus 24.2%; P=0.045).

Conclusions

In young patients with cryptogenic stroke, there is a high prevalence (41.9%) of PFO. Future cryptogenic stroke classification schemes should consider including PFO as a separate etiologic category.

Background and Aims

Cerebral venous sinus thrombosis (CVST) is a rare medical occurrence that generally accounts for approximately 1% of all strokes. Hyperthyroidism, in general, and Graves' disease, in particular, can predispose to venous thromboembolism. The thyrotoxic phase of Graves' disease is associated with venous thrombosis caused by hypercoagulability, induced in part by increased levels of homocysteine and factor VIII, as well as decreased fibrinolytic activity. Patients with Graves' disease may also have autoantibodies that lead to platelet activation.

Methods

we report a case of a 21 years old male who presented to the ER department with a four weeks history, complaining of severe headache, nausea, vomiting and considerable weight loss (~12 kg within this time lapse).

Results

Neurological examination revealed no abnormalities. Supra-aortic CTA showed massive thrombosis involving right sigmoid and transverse sinus and right internal jugular vein. After admission, the patient got a head MRI, which showed the same imaging results. Laboratory studies revealed a normal blood cell count, normal kidney and liver functions and high values of C-Reactive-Protein and Fibrinogen. Physical examination noted a pretibial edema, raising the suspicion of a probable hyperthyroidism. A thyroid gland ultrasound confirmed the enlargement of both thyroid lobes, with increased vascularity. Thyroid function laboratory tests revealed: low TSH (0.0083 mIU/L), high value of fT3 (20.00pg/mL), high fT4 (3.51ng/dL), negative TPO Antibodies (3 IU/mL) and positive TSHR Antibodies (20.23 IU/L) suggesting Graves` disease.

Conclusions

Hyperthyroidism and Graves` disease in particular, are a risk factor for cerebral venous sinus thrombosis, even among young adults.

Background and Aims

The goals of the present analysis were to assess characteristics, treatments and 28-days case-fatality in ischemic strokes according to TOAST classification in Northern France.

Methods

All strokes occurring in adults between 2014 and 2019 were recorded in the population-based register in Lille city (including university and regional hospitals, private clinics, rehabilitation centers, nursing homes…). Case-fatality was calculated 28 days after the onset of symptoms. Associations between case-fatality and its associated factors were assessed by multivariate logistic regressions, adjusted for sex.

Results

We recorded 1440 ischemic strokes (cardioembolism (CE): 36%, undetermined cause (UND): 39%, large artery atherosclerosis (LAA): 10%, small-artery occlusion (SAO): 10%, other determined cause (OC): 5%). The average sex-ratio (m/f) was 0.9, except for CE (0.5) and LAA (1.7). The NIHSS score of CE was twice the one of SAO. After adjustment for age and sex, prevalence of histories of stroke (p<0.0001), coronary heart diseases (p<0.01) and atrial fibrillation (p<0.0001) differed among stroke subtypes. At entry, anticoagulants were more prescribed in CE than SAO (29% vs 7%, p<0.0001). Antihypertensive therapies concerned 65% of the population, but even more in CE (76%, p<0.001). Case-fatality was higher in CE (17%) and UND (14%) strokes than in LAA (6%) and SAO (3%). In multivariate analysis, stroke subtype, NIHSS score, age, atrial fibrillation and heparin were associated with a higher risk of case-fatality.

Conclusions

In this large recent population-based register, ischemic stroke case-fatalities remains elevated, especially for CE. Stroke etiology, severity and age are independent predictors of 1-month case-fatality, as well as atrial fibrillation and heparin.

Background and Aims

Stroke has high mortality and morbidity, is the second highest death rate in the world. The neutrophil to lymphocyte ratio was used to predict mortality in hemorrhagic stroke patients. This study objective is the relationship between neutrophil-lymphocyte ratio (NLR) as a predictor of death in hemorrhagic stroke patients at Dr. Zainoel Abidin General Hospital Banda Aceh, Indonesia.

Methods

An observational analytic study using a cohort study design at Dr. Zainoel Abidin General Hospital in September 2021 until. December 2021. Data analysis using Chi-Square test.

Results

RNL values ​​were associated with mortality in hemorrhagic stroke patients (OR 70,714 95% Cl, p= 0.000). Thus, it can be said that patients who have an RNL value > 8.4 have a 70 times higher risk of death compared to an RNL value of 8.4.

Conclusions

The NLR cut-off point can be used to assess the mortality outcome of hemorrhagic stroke patients.

Background and Aims

Prevalence of ischemic stroke (IS) in the youth has increased in the last decades. Raise of modifiable vascular risk factors (VRF) in this population has been identified, previously seen only in older adult patients. Our objective is to determine the frequency of classic VRF in young patients with IS compared to those considered very young.

Methods

Analytic study of a prospective cohort of young patients(18-55yo) with IS, between 2015 and 2022, which were divided into two groups: very young(18-35yo) and young(36-55yo). Their epidemiological characteristics and risk factors (hypertension, diabetes, obesity, tobacco use, migraine, and others) were compared. A logistic regression analysis was done, obtaining adjusted odds ratios (aOR).

Results

A total of 270 patients were included, 154(57.7%) men. 76(28.4%) in the very young group (28±5yo) and 194(71.6%) in the young (45±6yo). Frequency of VRF like diabetes, hypertension, tobacco use, and myocardial infarction was significantly higher in young patients, and migraine in very young patients. Diabetes (aOR4.37, CI95%,1.35-14.13), hypertension (aOR2.38, CI95%,1.38-5.77), and overweight (aOR2.13, CI95%,1.07-4.27) were more likely to be present in >35yo patients. Although the small sample for the very young group, a non-significant trend towards a higher frequency of autoimmunity, prior thrombosis and migraine was identified. Main cause of IS was cervical dissection in both groups. Large vessels atherosclerosis/lacunar infarcts were more frequent in young group (17% vs 2.6%).

Conclusions

The risk factor profile of young stroke patients may be different, with higher frequencies of classic VRF in those >35yo. Acknowledging this could help improve primary prevention strategies.

Background and Aims

Ischemic Stroke (IS) is associated with various modifiable risk factors but the association of these risk factors based on TOAST classification is unknown. We aimed to summarize the published evidence for the association of modifiable risk factors with IS subtypes based on TOAST classification.

Methods

A comprehensive search for all the published articles was performed in electronic databases including PubMed, EMBASE, Cochrane Library, and Google Scholar from 01^st January 1950 to 31st March 2022. Odds ratio (OR) with 95% Confidence interval (CIs) along with random effect models were used to calculate summary estimates.

Results

In our meta-analysis, 32 studies with a total of 23,404 IS, 7,121 large-artery atherosclerosis (LAA), 5,532 small-vessel occlusions (SVO), and 3,498 Cardioembolism (CE), 1,131 strokes of other determined etiology (ODE) and 4,519 stroke of undetermined etiology (UDE) were included. Our findings suggest a significant association between LAA and hypertension (OR=1.07, 95% CI=1.02-1.12), smoking (OR=1.11, 95% CI=1.04-1.17), dyslipidemia (OR=1.13, 95% CI=1.06-1.21), Diabetes Mellitus (OR=1.18, 95% CI=1.11-1.25) and Atrial Fibrillation (OR=0.55, 95% CI=0.40-0.75) in overall as well as in Asian and Caucasian studies.. A significantly strong association between hypertension, smoking, dyslipidemia, DM, and AF was also observed with SVO and CE stroke subtypes. Hypertension was only significantly associated with SVO and ODE subtypes in both Asians and Caucasians; however, only the Asian population showed a significant association of hypertension in LAA and CE subtypes.

Conclusions

A strong association between smoking, dyslipidemia, and DM with LAA and SVO subtypes of ischemic stroke was found.

Background and Aims

Ischemic stroke recurs in about 25% following the first-ever ischemic stroke. It is important to determine and differentiate risk factors for recurrence as compared to index stroke.

Methods

This prospective study was done at a university teaching hospital from May 2020 to September 2021 after obtaining informed consent and institutional ethical clearance. Patients with radiologically confirmed ischemic strokes were divided into two groups as first-ever and recurrent strokes. Systematic evaluation of demographic details, symptom duration, progression, risk factors, biochemical & radiological data were obtained, and statistical analysis was done using R software.

Results

One-hundred-fifty patients with ischemic stroke (75 in each group) were included in the study. Non-modifiable risk factors associated with stroke recurrence were age (p=0.023) and illiteracy (p=0.05). Aphasia (p=0.01) and generalized seizure (p=0.023) were more frequent in recurrent stroke group. Hypertension (p=0.01), ischemic heart disease (p=0.019), obesity (p=0.001), antiplatelet medication non-adherence (p=0.001), intracranial atherosclerosis (p=0.001), and anemia (p=0.001) were modifiable risk factors associated with stroke recurrence. Large artery atherosclerosis and cardioembolism were key mechanisms for stroke recurrence. A small number of intermediate metabolizers of clopidogrel were found. Pressure sore, hypoproteinemia, urinary tract infection, pneumonia, sepsis, azotemia, and hypokalemia were significant complications during the recurrent stroke. mRS and NIHSS at discharge did not differ significantly.

Conclusions

Our study demonstrated that prominent vascular risk factors for recurrence include uncontrolled hypertension, long duration of diabetes, obesity, left atrial enlargement, non-adherence to medication, intracranial atherosclerosis, and anemia. Limitations of our study include hospital-based assessment and lack of aspirin resistance data.

Background and Aims

The majority of ischemic strokes belong to the cryptogenic etiological subtype. Atrial cardiopathy can be the etiology of this cryptogenic stroke especially the ESUS type. In the TOAST classification cryptogenic stroke belongs to the undetermined category. This study was performed to find atrial cardiopathy in various subtypes of ischemic stroke classified according to TOAST criteria.

Methods

110 acute ischemic stroke patients were enrolled. Using clinical data, radiological images, and investigation results, the stroke subtype of each patient was determined based on TOAST classification. Atrial cardiopathy was determined by the presence of any one of the following criteria PTFV1> 5000 μV·ms, NT-proBNP level > 250 pg/ml, or severe left atrial enlargement(≥ 5.2 cm in men or ≥ 4.7 cm in women). The distribution of atrial cardiopathy in each group was analyzed and inferences were drawn.

Results

Atrial cardiopathy by LA diameter was found equally in the cardioembolic and undetermined group i.e. 38.46 % as compared to other groups. Atrial cardiopathy by serum NT proBNP Criteria was significantly higher in patients with cardioembolic, undetermined group (48.78%, 24.39% respectively) as compared to other groups. Atrial cardiopathy by ECG criteria (PTFV1>5000 microvolt milli second) was significantly higher in, the undetermined group (44.12%) as compared to other groups

Conclusions

Every patient of undetermined cause of stroke (cryptogenic stroke) should be evaluated for atrial cardiopathy. Every patient should be evaluated with left atrial size, NT pro-BNP, and PTFV1. These three parameters will add to our management of atrial cardiopathy as a modifiable stroke risk factor.

Background and Aims

Transcranial Doppler (TCD) can detect emboli in numerous cerebrovascular settings. Although previous studies have suggested that microembolic signals (MES) may predict recurrent stroke, the practical significance of such findings remains unclear. This uncertainity has deterred the widespread use of embolic monitoring among clinicians.

Methods

All ischemic stroke patients (n=186) admitted to stroke unit in our hospital who underwent MES monitoring from January 2017 to December 2021 were reviewed. A detection threshold of >9.00 dB was used.

Results

6±10 MES were detected in 19% of patients at an average of 14 ± 4.4 dB

Recurrent stroke was seen in 10% of patients ( monitoing over 10±6 days)

Patients with MES

1.More likely to have recurrent stroke (36% vs 3%, p=<0.005)

2.Undergo a revascularization procedure ( following TCDs) (29% vs 6%, p=0.005)

3.Longer length of stay (10 vs 5 days, p=0.001)

4.Discharge mRS 3-6 (72 % vs27%, p < 0.001)

Multivariable logistic regression analysis:

MES was an independent predictor of recurrent stroke

(OR 32.4,95% CI 8.6- 186.8) and of poor discharge mRS 3-6

(OR 10.7, 95% CI 5.0- 41.7) despite controlling for other stroke subtypes, antithrombotics, stroke severity, and age.

Conclusions

In our series of patients who underwent embolic monitoring with TCD, MES predicted ischemic stroke recurrence leading to worsened disability and prolonged hospital stays. Given that MES can provide important prognostic information. TCD with embolic monitoring may be clinically useful in the workup of ischemic stroke.

Background and Aims

Secondary prevention strategies are key in reducing recurrent ischaemic events. Non-adherence to medications for secondary stroke prevention is a common issue. Functional outcomes are stroke vary and influence concern for recurrent events. We aimed to study the association of post-stroke outcome with adherence to medications for secondary stroke prevention. contributing to suboptimal health outcomes.

Background and Aims

Secondary prevention strategies are key in reducing recurrent ischaemic events. Non-adherence to medications for secondary stroke prevention is a common issue. Functional outcomes are stroke vary and influence concern for recurrent events. We aimed to study the association of post-stroke outcome with adherence to medications for secondary stroke prevention. contributing to suboptimal health outcomes.

Methods

This was a prospective cohort of patients recruited from post-stroke outpatient clinics at Singapore General Hospital from October 2018 to April 2019. The inclusion criteria were ischaemic stroke or transient ischaemic attack (TIA) patients, age >21 years, and ability to provide informed consent. We assessed medication adherence using the Medication Adherence Report Scale (>24 points considered adherence). Functional outcome after stroke, at the time of recruitment was assessed using the modified Rankin score (mRS).

Methods

This was a prospective cohort of patients recruited from post-stroke outpatient clinics at Singapore General Hospital from October 2018 to April 2019. The inclusion criteria were ischaemic stroke or transient ischaemic attack (TIA) patients, age >21 years, and ability to provide informed consent. We assessed medication adherence using the Medication Adherence Report Scale (>24 points considered adherence). Functional outcome after stroke, at the time of recruitment was assessed using the modified Rankin score (mRS).

Results

Amongst the 200 patients, 184 (92 %) had mRS data (mean age 63 years, 55% female), 66.3 % had mRS 0-1. The adherence rate was higher in patients who were of mRS>1 (69%) compared to those who were of mRS 0-1 (42%) (p=0.001). Patients who were adherent were younger than those who were not (61 SD vs 66 SD, p=0.001). Patient who had mRS 0-1 were 2.56 (95% CI 1.312 vs 4.99) times more likely to be non-adherent to medications (p=0.006).

Results

Amongst the 200 patients, 184 (92 %) had mRS data (mean age 63 years, 55% female), 66.3 % had mRS 0-1. The adherence rate was higher in patients who were of mRS>1 (69%) compared to those who were of mRS 0-1 (42%) (p=0.001). Patients who were adherent were younger than those who were not (61 SD vs 66 SD, p=0.001). Patient who had mRS 0-1 were 2.56 (95% CI 1.312 vs 4.99) times more likely to be non-adherent to medications (p=0.006).

Conclusions

Conclusions

Patients who have no disability after stroke are more likely to be non-adherent to medications prescribed for secondary stroke prevention and should be targeted more specifically for strategies to improve compliance.

Background and Aims

To investigate the association between estimated glomerular filtration rate (eGFR) and 1-year mortality in patients aged>=75 years with acute ischemic stroke (AIS).

Methods

Patients aged>=75years with AIS were selected and followed up for 3 months and 1 year to register whether the patients died or not during the follow-up. The eGFR were treated according to the continuous variable and the quartile variable (Q1-Q4 ). Univariate and multivariate Cox regression analysis was performed to study the association between eGFR and 1 year mortality in patients aged >=75 years with AIS.

Results

Total 506 patients aged >=75years with AIS were enrolled in this study. At the end of follow-up, eGFR levels at the 3 months and 1-year mortality were significantly higher in the Q1, compared with other groups, with statistically significant differences (P<0.001). Multivariate Cox regression analysis result showed that for every 5 mL/min/1.73 m² increase in eGFR level, the risk of 1-year mortality in patients aged>=75 years with AIS decreased by 12% (HR=0.88, 95%CI: 0.81~0.96，P=0.002); Compared with the Q4 group, the risk of 3 months mortality and 1-year mortality was significantly increased by 1.89 and 1.3 times, respectively (3 months: HR=2.89, 95%CI: 1.01~8.24，P=0.048; 1-year: HR=2.30, 95%CI: 1.13~4.67，P=0.022) when eGFR levels at Q1 group. Kaplan-Meier survival analysis found a significant decrease in survival in the Q1 group compared to the other groups.

Conclusions

Decreased of eGFR level is an independent risk factor for 1-year mortality in patients aged>=75 years with AIS, and the 1-year mortality is significantly increased when the level of eGFR <60.2 mL/min/1.73m².

Background and Aims

To investigate the rate of early stroke-related death and risk factors in patients with Acute ischemic stroke (AIS) in Xi’an city, and to provide theoretical basis for reducing the risk of early death in patients with AIS.

Methods

The clinical data and the rate of death during 90 days of follow-up from the date of diagnosis of 2340 AIS patients who were consecutively admitted to 4 tertiary-grade A class hospitals in Xi’an from January 2015 to December 2015 were collected. The rate of early stroke related death and its related risk factors were analyzed.

Results

Among 2340 AIS patients in Xi’an city, 78 patients occurred early stroke-related death, accounting for 3.3%. Multivariate unconditional logistic regression analysis showed that age³80 years (OR=4.487, 95%CI: 1.436~14.011), severe neurological impairment (OR=5.038, 95%CI: 1.781~14.244), pneumonia (OR=3.358, 95%CI: 1.679~6.713), elevated alkaline phosphatase (OR=1.007,95%CI: 1.002~1.012), elevated leukocyte count (OR=1.128, 95%CI: 1.041~1.223) were main risk factors for stroke-related death in AIS patients in Xi’an city.

Conclusions

The proportion of early stroke related death in AIS patients in Xi’an was relatively low and AIS patients with advanced age, severe neurological impairment, pneumonia, elevated alkaline phosphatase and elevated leukocyte count were more likely to have early stroke-related death.

Background and Aims

To investigate the risk factors of the 1-year poor prognosis of acute ischemic stroke (AIS) in Xi’an area and to establish a nomogram risk prediction model for 1-year poor prognosis.

Methods

The patients were followed up for 1 year after diagnosis. Univariate and multivariate logistic analysis were applied to analyzed the risk factors of 1-year poor prognosis of AIS patients. R software and rms package were used to establish a nomogram risk prediction model for 1-year poor prognosis of AIS patients.

Results

A total of 2201 AIS patients were included in this study. At the end of 1-year follow-up, 366 AIS patients had poor prognosis (16.6%), and 1835 AIS patients had good prognosis (83.4%). Multivariate Logistic regression analysis showed that age(OR＝1.069, 95%CI: 1.052~1.087, P=0.000)、complicated by pneumonia(OR＝3.121, 95%CI: 1.595~6.107, P=0.001)、leukocyte count(OR＝1.137, 95%CI: 1.062~1.217, P=0.000)、atrial fibrillation (OR＝1.816, 95%CI: 1.059~3.115, P=0.030), NIHSS score on admission (OR＝1.196, 95%CI: 1.153~1.241, P=0.000) were independent risk factors for 1-year poor prognosis of AIS patients in Xi'an area. Based on the above independent risk factors, a nomogram prediction model was established to predict 1-year poor prognosis in AIS patients. ROC curve showed that the area under the curve (AUC) was 0.846, showed good discrimination. Hosmer-Lemeshow test showed no significant difference .

Conclusions

In this study, a nomogram risk prediction model was successfully established. The model has good differentiation and calibration, and is simple, practical and easy to operate. It has certain guiding value for early identification of high-risk patients who may develop poor prognosis during 1 year.

Background and Aims

To estimate the genetic associations of modifiable risk factors with lacunar stroke and furthermore, demonstrate common anti-hypertension, lipid-lowering and antidiabetic agents in preventing Lacunar Stroke (LS).

Methods

Two-sample Mendelian randomization (MR) analyses was conducted. Common anti-hypertension, lipid-lowering and antidiabetic agents with LS were also estimated using drug-target MR.

Results

Among all 99 risk factors (i.e., Anthropometrics, serum substances, living habit), not surprisingly, genetically predicted hypertension (systolic blood pressure: OR, 1.06; 95% CI, 1.03-1.08; P =4.64E-7), hyperlipidemia and type 2 diabetes (OR, 1.16; 95% CI, 1.10-1.23; P =8.01E-8) showed significantly increase the risk of LS. Elevated triglycerides, apolipoprotein B and LDL cholesterol showed a causal detrimental effect on LS (OR,1.14), while those of apolipoprotein A-I and HDL were inversely associated with risk of LS (OR, 0.90). Furthermore, drug-target MR demonstrate genetic variation alleles (i.e., mimicking the effect of Calcium channel blockers, CCBs) showed the most stable effects in preventing LS. The genetic variation alleles at or near the HMGCR gene (i.e., mimicking the effect of statins), NPC1L1 (mimicking the effects of ezetimibe) and APOC3 (mimicking antisense anti-apoC3 agents) was predicted to decrease LS. GLP1R agonism showed no significant effects on LS while glycemic control showed protect people from LS.

Conclusions

The study provided solid genetic evidence to validate the main risk factors for LS. Drug-target MR showed CCBs, statins, ezetimibe, and anti-apoC3 agents had the most potential effects on preventing LS and should be given high priority when make decision.

Background and Aims

Stroke is a medical condition that leads to major disability and mortality worldwide. Some evidence suggests that weather and seasonal variations could impact stroke incidence and outcome. However, the current evidence is inconclusive. Therefore, this study examines the seasonal variations and meteorological influences on stroke incidence and outcome in the largest city in Saudi Arabia.

Methods

From February 2016 to July 2019, we retrospectively reviewed data from all patients with acute ischemic (AIS) or hemorrhagic stroke (HS) admitted to the stroke unit in a tertiary academic center in Saudi Arabia. The corresponding daily meteorological data were obtained for the same period. We considered the months from November to March as the cold season and April to October as the hot season.

Results

The final cohort included 1,271 stroke patients; 60.89% (n = 774) cases occurred in the hot season, while 39.1% (n = 497) in the cold season. Males accounted for 69.6% (n = 884) of the cases. The proportion of ischemic stroke was 83.2% [hot season 83.9% (n = 649) vs. cold season 82.3% (n = 409)]. We found no statistically significant difference between seasons (hot or cold) in stroke incidence, severity [National Institutes of Health Stroke Scale (NIHSS)], hospital course (pneumonia, thromboembolism, intensive care stay, or length of stay), or outcome [modified Rankin scale (mRS) on discharge and death].

Conclusions

In Riyadh, Saudi Arabia, our study found no impact of weather or seasonal variations on stroke incidence, hospital course, or outcomes. However, our findings warrant further research in different country regions.

Background and Aims

Few have systematically clarified CVDand all-cause mortality attributable to individual and combined cardiometabolic risk factors. We aimed to investigate individual and combined associations and population attributable fraction (PAF) of cardiometabolic risk factors, including hypertension, diabetes and dyslipidemia, on CVD and all-cause mortality, and calculate reductions in CVD-free years and life expectancy.

Methods

22660 participants aged ≥ 35 were included and CVD events and mortality were followed up in 2018 and 2019. Cox regression was applied to evaluate the association of cardiometabolic risk factors with CVD and all-cause mortality. We described PAF for CVD and mortlaity, and reductions in CVD-free years and life expectancy.

Results

During the 4.92 years of follow-up, we detected 438 CVD and 1128 deaths. HR were 1.57 (95% CI 1.32-1.86), 1.71 (95%CI 1.42-2.08) and 2.34 (95%CI 1.74-3.09) for CVD and 1.54 (95%CI 1.32-1.79), 1.45 (95%CI 1.21-1.75) and 2.36 (95%CI 1.80-3.09) for all-cause mortality, respectively, in participants with one, two or three cardiometabolic risk factors compared with participants without diabetes, hypertension, and dyslipidemia. The PAFs for total CVD and mortality attributable to all cardiometabolic risk factors were 24.52% (95%CI 24.11-24.94) and 22.11% (95%CI 21.75-22.49), respectively. We estimated that participants aged between 40 and 60 years old, with three cardiometabolic disorders, had approximately 2.4 and 3.3 years of reduced CVD-free years and life expectancy.

Conclusions

Cardiometabolic risk factors were additively associated with a higher risk of CVD and all-cause mortality. A large proportion of CVD and all-cause mortality and reduction in CVD-free years and life expectancy were significantly associated with cardiometabolic risk factors.