Cerebrovascular risk factors and their time-dependent effects on stroke survival in the EMMA cohort study

To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.

Fasting Glucose is a Useful Indicator for Cerebrovascular Risk in Non-Diabetic Koreans: Association With Oxidative Stress and Inflammation

Diabetes and impaired fasting glucose are associated with incidence of cerebro-/cardio-vascular diseases. This study hypothesized that fasting glycemic status may reflect cerebrovascular risk in non-diabetic Koreans. Fasting glycemic status, lipid profiles, oxidative stress, and inflammation markers were measured in non-diabetic subjects (healthy controls, n = 112 and stroke n = 41). Systolic blood pressure, fasting glucose, glycated hemoglobin (HbA1C), triglycerides, high sensitivity C-reactive protein (hs-CPR), interleukin-6, and tumor necrosis factor-alpha were higher, and high density lipoprotein (HDL)-cholesterols were lower in patients with stroke than healthy controls. Fasting glucose positively correlated with hs-CRP, interleukin-6, tumor necrosis factor-alpha, oxidized low density lipoprotein (LDL) and malondialdehyde. The significances continued or at least turned to a trend after adjustments for confounding factors. Multiple regression analyses revealed that fasting glucose was mainly associated with cerebrovascular risk (beta'-coefficient = 0.284, p < 0.0001) together with age, systolic blood pressure, total cholesterol, hs-CRP, body mass index, dietary poly unsaturated fatty acid/saturated fatty acid (PUFA/SFA), and HbA1C (r2 = 0.634, p = 0.044). The subjects were subdivided by their fasting glucose levels [normal fasting glucose: 70-99 mg/dL, n = 91 [NFG-control] and n = 27 [NFG-stroke]; higher fasting glucose: 100-125 mg/dL, n = 21 [HFG-control] and n = 14 [HFG-stroke]). In both controls and stroke patients, HFG groups show higher triglyceride, total- and LDL-cholesterol and lower HDL-cholesterol than NFG groups. Control-HFG group showed significantly higher levels of oxidative stress and inflammation than control-NFG group. Stroke-HFG group also showed significantly higher inflammatory levels than stroke-NFG group, moreover the highest among the groups. Additionally, stroke-NFG group consumed higher PUFA/SFA than stroke-HFG group. Fasting glucose may be a useful indicator for cerebrovascular risk in non-diabetic individuals which may be mediated by oxidative stress and inflammation status.

Comparison of White Matter Lesions on the Magnetic Resonance Imaging in Major Depression and Vascular Depression

OBJECTIVES: The aims of this study were to identify the frequency and severity of white matter lesions on MRIs of late-life depression and deppression due to cerebrovascular diseases (vascular depression), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late-life depression. DESIGN: The frequency and severity of the periventricular hyperintensity and the deep white matter hyperintensity were measured on the brain MRIs in the patients with major depression, vascular depression and neurotic controls over 50 yrs of age. The association of the white matter lesions with cerebrovascular risk factors were evaluated. MATERIALS AND METHODS: The MRI films of 32 patients (15 males & 17 females) with major depression over 50 yrs of age, 25 patients (17 males & 8 females) with vascular depression, and 25 neurotic controls (6 males & 19 females) were analyzed for the white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnoramlities, EKG abnormality, stroke, etc were also assessed. RESULTS: 1) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with vascular depression and major depression than in neurotic controls. 2) The intracerebral hyperintensities or classical infarctions were prevalent in frontal cortex (32.0%) and in basal ganglia (40.0%). 3) Among cerebrovascular risk factors, stroke (p<0.005), hypertension (p<0.025), EKG abnormality (p<0.005) and smoking (p<0.05) were significantly prevalent in the patients with vascular depression and major depression as compared with neurotic controls. 4) The severity of white matter lesions were significantly associated with the cerebrovascular risk factors (p<0.005) in patients with major depression over 50 yrs of age. CONCLUSIONS: The white matter hyperintensities on brain MRIs of patients with major depression over 50 yrs of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late-life depression.