Author Interviews, JAMA, Johns Hopkins, Race/Ethnic Diversity, Stroke / 25.07.2016 Interview with: Romanus Roland Faigle, M.D., Ph.D. Assistant Professor of Neurology The Johns Hopkins Hospital What is the background for this study? Response: Stroke care entails a variety of procedures and interventions, which generally fall into one of the two following categories: 1) curative/preventative procedures (such as IV thrombolysis and carotid revascularization), which intent to prevent injury and restore function; and 2) life-sustaining procedures (such as gastrostomy, mechanical ventilation, tracheostomy, and hemicraniectomy), which intent to address complications from a stroke and to prevent death. The use of curative/preventative procedures is supported by excellent evidence and is guided by well-defined criteria, while those are largely lacking for life-sustaining procedures. Therefore, curative/preventative are desirable for eligible patients, while life-sustaining procedures indicate the need to address undesired complications and in itself have questionable utility. We wanted to determine whether race differences in the use of the individual stroke-related procedures exist, and whether presence and directionality of differences by race follow a pattern unique to each of the 2 procedure groups. (more…)
AHA Journals, Author Interviews, Gender Differences, Stroke, Tobacco Research / 23.07.2016 Interview with: Joni Valdemar Lindbohm, MD Department of Public Health University of Helsinki, Finland What is the background for this study? Response: Approximately 1-6% percent of people carry an unruptured intracranial aneurysm but most of these never rupture during lifetime and cause subarachnoid hemorrhage (SAH). In SAH, the rupture of an aneurysm causes bleeding into the lining between the brain’s surface and underlying tissue. Despite advances in operative techniques, SAH can lead to death in up to 45% of the cases. Because life style risk factors are critical in development of subarachnoid hemorrhage, it is important to characterize the risk factor profile of those with an elevated risk. Widely accepted risk factors for SAH are increasing age, smoking, hypertension and female sex. However, the reasons for an elevated risk in women have remained uncovered and the effect of smoking habits are not well understood. (more…)
Author Interviews, Dental Research, Stroke / 20.07.2016 Interview with: Dr. Yago Leira, DDS Pre-Doc researcher at Health Research Institute of Santiago de Compostela (Spain) and Department of Periodontology, Faculty of Medicine and Dentistry University of Santiago de Compostela (Spain) What is the background for this study? Response: Periodontal disease is a chronic oral inflammatory disease caused by bacterial infection, which affects 20% to 50% of the adult population. Lacunar stroke, a type of cerebral small vessel disease, is responsible for almost 25% of the ischaemic strokes. It may be hypothesized that chronic periodontitis leads to a low-grade state of systemic inflammation altering endothelial function and blood vessels health, which could be related to the onset of atherosclerosis. Moreover, lacunar stroke could be linked with an inflammation process that can be associated with endothelial dysfunction. In the last decade, several observational studies have suggested an association between periodontal disease and ischaemic stroke. However, none of them have studied the relationship between chronic periodontitis and lacunar stroke independently of known vascular risk factors that both diseases may share (e.g., ageing, hypertension, diabetes mellitus or hypercholesterolemia). (more…)
Author Interviews, NYU, Race/Ethnic Diversity, Sleep Disorders, Stroke, Weight Research / 09.07.2016 Interview with: Azizi Seixas, Ph.D. Post-Doc Fellow Department of Population Health Center for Healthful Behavior Change NYU School of Medicine What is the background for this study? What are the main findings? Response: Compared with whites, blacks are disproportionately affected by strokes. The overwhelming prevalence of obesity among blacks compared to whites has been suggested as a possible explanation for the disproportionate rates of strokes among blacks compared to whites. Recent findings linking insufficient sleep and stroke as well as the disproportionate burden of insufficient sleep among blacks compared to whites might provide a unique mechanism explaining why blacks have higher rates of stroke. However, it is unclear whether insufficient sleep and obesity contributes to the higher rates of stroke among blacks compared to whites. To test our hypothesis, we utilized data from the National Health Interview Survey from 2004-2013 with a sample size of 288,888 individuals from the United States. Using Bayesian Belief Network (BBN) analysis, a form of machine learning analysis, we assessed the mediating effects of BMI on the relationship between short sleep duration (≤6 hrs. total sleep duration), long sleep duration (≥9 hrs. total sleep duration), and stroke, and whether race/ethnicity differences in obesity moderated these relationships. (more…)
Author Interviews, Brigham & Women's - Harvard, Race/Ethnic Diversity, Stroke / 04.07.2016 Interview with: Nilay Kumar M.B.B.S. Attending physician at Cambridge Health Alliance, Cambridge, MA Instructor in Medicine at Harvard Medical School Boston, MA What is the background for this study? What are the main findings? Response: Racial differences in stroke mortality have major health policy implications. A large body of evidence has shown significant racial differences in the incidence of stroke and associated mortality rate (death due to stroke per unit population per year) in the United States. Few studies to date have addressed racial differences in in-hospital outcomes after acute ischemic stroke using population level datasets. Previous studies have shown inconsistent results with respect to racial differences in in-hospital case fatality rate after acute ischemic stroke. Additionally, racial minorities have been known to be less likely to receive evidence based reperfusion therapies for several cardiovascular diseases including acute myocardial infarction and ischemic stroke. Previous studies on racial differences in stroke outcomes have rarely included Asian and Pacific Islanders. Against this background, we aimed to ascertain racial differences in outcomes of acute ischemic stroke hospitalization in the US using a nationally representative sample. (more…)
Author Interviews, Genetic Research, JAMA, Stroke / 28.06.2016 Interview with: Dr. Yongjun Wang  Principal Investigator No. 6 Tiantanxili Dongcheng District, Beijing, China What is the background for this study? What are the main findings? Response: Clopidogrel requires conversion to an active metabolite by hepatic cytochrome p450 (CYP) iso-enzymes to exert an antiplatelet effect, and polymorphisms of the CYP2C19 gene have been identified as strong predictors of clopidogrel nonresponsiveness. However, data are limited regarding the association between CYP2C19 genetic variants and clinical outcomes of clopidogrel-treated patients with minor stroke or transient ischemic attack. The main findings of this study is that the combined treatment of clopidogrel and aspirin compared with aspirin alone reduced the risk of a new stroke only in the subgroup of patients with minor ischemic stroke or TIA who were not carriers of the CYP2C19 loss of function alleles. (more…)
Author Interviews, MRI, Neurological Disorders, Neurology, NIH, Stroke / 22.06.2016 Interview with: Dr. Richard Leigh MD Neuro Vascular Brain Imaging Unit National Institute of Neurological Disorders and Stroke National Institutes of Health, Bethesda, MD What is the background for this study? What are the main findings? Response: Patients who suffer an ischemic stroke have limited treatment options. One of the reasons for this is that our treatments can sometimes make the stroke worse by transforming the ischemic stroke into a hemorrhagic stroke. In our study we identified a new piece of information that we can extract from the patient’s MRI scan that informs us on the risk of having a hemorrhage. (more…)
Author Interviews, Brigham & Women's - Harvard, CT Scanning, JAMA, Stroke / 21.06.2016 Interview with: Dr. Gregoire Boulouis MD MS Research Fellow at Massachusetts General Hospital / Harvard Med. School Boston, Massachusetts What is the background for this study? What are the main findings? Dr. Boulouis: Hemorrhagic Stroke or Intracerebral hemorrhage (ICH) still has a poor prognosis. A substantial proportion of patients will experience ongoing intracranial bleeding and their hematomas will grow in size in the first hours following presentation, a phenomenon called 'hemorrhage epxansion'. Patients with hemorrhage expansion have been shown to have significantly worse clinical outcome. If all baseline ICH characteristics (location, initial hemorrhage volume, ..) are non modifiable at the time of diagnosis, hemorrhage expansion, however, represents one of the few potential targets to improve outcome in ICH patients. An accurate selection of patients at high risk of expansion is needed to optimize patients' selection in expansion targetted trials and, eventually, to help stratifying the level of care at the acute phase. In this study, we investigated whether the presence of non-contrast Computed Tomography hypodensities within the baseline hematoma, a very easily and reliably assessed imaging marker, was associated with more hemorrhage expansion. A total of 1029 acute phase ICH patients were included ; approximately a third of them demonstrated CT hypodensities at baseline. In this population, CT hypodensities were independently associated with hemorrhage expansion with an odds ratio of 3.42 (95% CI 2.21-5.31) for expansion in fully adjusted multivariable model. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, JAMA, Stroke / 14.06.2016 Interview with: Alessandro Biffi, MD Behavioral Neurology and Neuropsychiatry Departments of Neurology and Psychiatry Massachusetts General Hospital / Harvard Medical School What is the background for this study? Dr. Biffi: Intracerebral Hemorrhage (ICH) is the most severe form of stroke. It is a form of hemorrhagic (i.e. bleeding) stroke that accounts for ~ 15% of all acute cerebrovascular conditions, affecting ~ 70,000 Americans every year. However, because of its severity it is responsible for almost half of all stroke-related disability worldwide. Survivors of ICH are at very high risk for cognitive impairment (up to and including dementia) following the acute cerebral bleeding event. However, we possess very limited understanding of the time dynamics and risk factors for post-ICH dementia. In particular, prior to our study it was unclear whether the acute cerebral injury due to ICH would be the only mechanism potentially responsible for subsequent development of dementia. This question is motivated by prior observations suggesting that Intracerebral Hemorrhage represents the acute manifestation of cerebral small vessel disease, a progressive degenerative disorder of small caliber arteries of the central nervous system. There exist two major subtypes of small vessel disease: 1) cerebral amyloid angiopathy, caused by the deposition of a toxic protein product, beta-amyloid, in the blood vessels (in a process similar to the formation of beta-amyloid plaques that cause Alzheimer's disease); 2) arteriolosclerosis, caused by long-standing elevated blood pressure. ICH survivors have been previously shown to harbor very severe small vessel disease, which has been linked to dementia in patients without cerebral bleeding. Our hypothesis was that early-onset dementia (occurring in the first 6 months after ICH) is a manifestation of the acute neurological damage associated with cerebral bleeding, whereas delayed onset dementia (developing beyond 6 months from the acute ICH event) is associated with known markers of small vessel disease, including imaging findings on CT/MRI and genetic markers (such as the APOE gene). (more…)
Author Interviews, Blood Pressure - Hypertension, NEJM, Stroke / 09.06.2016 Interview with: Adnan I. Qureshi, M.D Zeenat Qureshi Stroke Research Center University of Minnesota Minneapolis, MN What is the background for this study? What are the main findings? Dr. Qureshi: An acute hypertensive response in patients with intracerebral hemorrhage is common and may be associated with hematoma expansion and increased mortality. The Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) trial was designed to determine the efficacy of rapidly lowering systolic blood pressure in patients in an earlier time window after symptom onset than evaluated in previous trials. The trial was based on evidence that hematoma expansion and subsequent death or disability might be reduced with very early and more aggressive reduction in systolic blood pressure in those at higher risk due to presence of high systolic blood pressure at presentation. The trial randomized eligible subjects with intracerebral hemorrhage to test the superiority of intensive (goal 110-140 mmHg) over standard (goal 140-180 mmHg) systolic blood pressure reduction using intravenous nicardipine within 4.5 hours of symptom onset. Of a total of 1000 subjects that were recruited with a mean (standard deviation) baseline systolic blood pressure of 200.6 (27.0) mmHg, 500 were assigned to intensive-treatment and 500 to standard-treatment. Enrollment was stopped following a pre-specified interim analysis because of futility. The primary endpoint of death or disability at 3 months post-randomization was observed in 38.7% (186/481) of subjects receiving intensive treatment and 37.7% (181/480) subjects receiving standard treatment (relative risk: 1.03; 95% confidence interval: 0.85 to 1.27), adjusted for age, initial Glasgow Coma scale, and presence or absence of intraventricular hemorrhage. The rate of renal adverse events within 7 days of randomization was significantly higher among subjects randomized to intensive treatment. Compared to a target systolic blood pressure of 140-180 mmHg, treating subjects with intracerebral hemorrhage to a target systolic blood pressure of 110-140 mmHg did not lower the rate of death or disability. (more…)
Author Interviews, Race/Ethnic Diversity, Stroke / 04.06.2016 Interview with: George Howard, Dr.P.H. Professor of biostatistics Birmingham School of Public Health University of Alabama What is the background for this study? What are the main findings? Dr. Howard: What has been known for many decades is that death rates from stroke are much higher in the black than white population, particularly between the ages of 45 – 65 (or maybe even a little older). These racial differences in stroke are among the greatest disparities for any disease, clearly it is a priority to reduce this disparity. However, there are two reasons more blacks could die from a disease: 1) more blacks get the disease, or 2) once you get the disease, it is more likely to kill blacks. The implications of knowing which of these is the major contributor is profound. If the driving force is more blacks are having more stroke, then we need to focus out attention on activities before stroke occur. For example, prevention of the greater prevalence of hypertension and diabetes in blacks, and also reducing the differences in the control of blood pressure and glucose. However, if the driving force is a higher chance of death in blacks once stroke occur, then we need to focus on the disparities in how black stroke patients are cared for compared to white stroke patients. That is, the former requires community-based efforts, while the latter requires hospital-based efforts. What we found was that nearly all the difference was that blacks are having more strokes ... not that they are more likely to die once stroke occurs. (more…)
Author Interviews, Circadian Rhythm, Endocrinology, Lifestyle & Health, Occupational Health, Sleep Disorders, Stroke / 02.06.2016 Interview with: David Earnest, Ph.D. Professor in the Department of Neuroscience and Experimental Therapeutics Texas A&M Health Science Center College of Medicine What is the background for this study? What are the main findings? Dr. Earnest: When body clocks are disrupted, as they are when people engage in shift work or go to bed and get up at radically different times every few days, more severe ischemic strokes can result. What should readers take away from your report? Dr. Earnest:  Whenever possible, go to bed and get up at the same time each day and keep regular mealtimes. If you do need to keep an irregular schedule, it is especially important to be mindful of stroke risk and try especially hard to eliminate other risk factors, such as hypertension and obesity. (more…)
AHA Journals, Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Stroke / 23.05.2016 Interview with: Kazem Rahimi, DM, MSc Oxford Martin School University of Oxford United Kingdom What is the background for this study? Dr. Rahimi: Vascular dementia is the second most common cause of dementia and is increasing in prevalence worldwide. Vascular dementia often occurs after stroke and can cause apathy, depression, and a decline in cognitive function, and can eventually result in death. High blood pressure (BP) has been identified as a potential risk factor for the development of vascular dementia. However, previous studies, which have been small in size, have reported conflicting results on the relationship between blood pressure and vascular dementia. (more…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 12.05.2016 Interview with: Lucas Ramirez, M.D Resident Physician | LAC-USC Medical Center USC Keck School of Medicine | Class of 2013 What is the background for this study? What are the main findings? Dr. Ramirez: Prior studies have shown differences in stroke rates in certain geographical regions among age and racial groups. Few studies have analyzed these differences on a national level.  Our study found that nationally, stroke hospitalization have decreased, though among blacks and young age groups, they have increased. (more…)
Author Interviews, NEJM, Stroke / 10.05.2016 Interview with: Professor Craig Anderson Professor of Stroke Medicine and Clinical Neuroscience Sydney Medical School at the University of Sydney Institute of Neurosciences of Royal Prince Alfred Hospital What is the background for this study? Prof. Anderson: Intravenous use of the clot-busting drug, alteplase (or rtPA), at a dose of 0.9 mg/kg body weight is the only proven medical treatment of acute ischemic stroke.  However, a  major drawback to the treatment is an increased risk of major bleeding in the brain, or intracerebral hemorrhage (ICH), that occurs in about 5% of cases, and can be fatal.  This balance of effectiveness (recovery from disability) and risks (ICH, and bleeding elsewhere and uncommon drug allergic reactions) has led to much of the controversy over the net benefit of the drug.  The optimal dose of the drug has never been established, but the Japanese drug safety regulatory authority, has approved a lower dose (0.6mg/kg) on the basis of a small, non-randomized, open study which showed comparable outcomes and lower risk of ICH than historical controls.  This ‘east-west’ divide over the approved dose of alteplase has led to much variation in the dose of alteplase used in clinical practice in Asia – according to a doctor’s perceived risk of ICH in individual patients and the affordability of this relatively expensive treatment in low resource settings.  Data from the Get-with-the Guidelines Quality Registry in the United States suggests Asian patients are at higher risk of ICH after standard-dose alteplase than non-Asians. Our research aimed to resolve this uncertainty over the optimal dose of alteplase, as an international, active-comparator, open-label, blinded outcome assessed, clinical trial of low-dose (0.6 mg/kg) versus standard-dose (0.9mg/kg) in 3310 patients recruited from over 100 hospitals in 13 countries between 2012 and 2015. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 04.05.2016 Interview with: Dr. Ben Freedman OAM  Deputy Director Research Strategy, Heart Research Institute/Charles Perkins Centre Professor of Cardiology, Sydney Medical School Head Vascular Biology Anzac Research Institute Honorary VMO, Concord Repatriation General Hospital University of Sydney What is the background for this study? Dr. Freedman: Guidelines recommend that patients with atrial fibrillation (AF) at high enough risk for stroke should be treated with anticoagulant. Anticoagulant drugs are remarkably effective in reducing stroke risk by about two thirds, and death by between a quarter and a third. Unfortunately, strokes can still occur when patients are prescribed anticoagulant for Atrial Fibrillation, and it is often presumed this residual risk of stroke represents treatment failure, though there are few data about this important issue. What are the main findings? Dr. Freedman: We were able to compare the risk of stroke in a cohort of patients with AF commenced on anticoagulant, with a very large closely-matched cohort seen in general practice at the same time but without AF. This is a unique comparison. We found that the residual risk of stroke in such anticoagulant-treated patients was virtually identical to that in the matched control cohort. The implication is that the residual risk of stroke may not be treatment failure, but the risk of non-cardioembolic stroke in people of a similar age and stroke risk profile but without Atrial Fibrillation. The residual risk of death in those on anticoagulant was higher than the matched controls, and intermediate between the control rate and the mortality rate for untreated AF. (more…)
Author Interviews, Heart Disease, Stroke / 25.04.2016 Interview with: Professor Ralph Stewart MBChB (Otago), FRACP, FCSANZ, MD Auckland City Hospital University of Auckland, New Zealand What is the background for this study? What are the main findings? Dr. Stewart: A number of studies have suggested a favorable effect of a Mediterranean dietary pattern on the risk of heart disease, but few large studies have evaluated this dietary pattern in a global population of patients with known coronary heart disease.  We assessed a Mediterranean diet score based on frequency of consumption of common foods using a very simple questionnaire.  Globally this included a very broad range of diets – showing the benefits of this dietary pattern  can be achieved with many different foods. We founds that greater adherence to this diet was associated with a lower risk of recurrent heart attacks, strokes and deaths from any cause.  In contrast a western diet score, which measured more consumption of foods thought to be unhealthy, including processed carbohydrates, sweetened foods and drinks and deep fried foods were not associated with the risk of cardiovascular events. (more…)
Author Interviews, Outcomes & Safety, Stroke / 25.04.2016 Interview with: Mathew J. Reeves, PhD Department of Epidemiology and Biostatistics Michigan State University East Lansing, MI What is the background for this study? What are the main findings? Dr. Reeves:   The transfer of stroke patients with ischemic stroke to primary and comprehensive stroke centers so they can receive specialized care including tPA (thrombolysis) and endovascular (catheter based) care is becoming increasingly important with the release or trial data showing substantial benefit for endovascular treatment in eligible patients.   A major goal of integrated stroke systems of care is to ensure that stroke patients requiring specialized care beyond the capability of the initial hospital are identified and transferred to a specialist center as quickly as possible.   Surprisingly, there is relatively little written about the frequency and outcomes of stroke patients who are transferred between hospitals, especially in the context of large quality improvement registries such as the Coverdell Stroke Registry or Get-With-The- Guidelines- Stroke (more…)
Author Interviews, JAMA, Stroke / 20.04.2016 Interview with: Dr. Georgios Tsivgoulis MD Department of Neurology, The University of Tennessee Health Science Center, Memphis Second Department of Neurology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece Medical Research: What is the background for this study? Dr. Tsivgoulis: Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding, but there are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Medical Research:  What are the main findings? Dr. Tsivgoulis: We analyzed data from 9 prospective cohort studies, comprising 2479 total AIS patients, to investigate the association of high cerebral microbleed burden (>10 CMBs on pre-IVT MRI-scan) with the risk of sICH following IVT for AIS from. The risk of sICH after IVT was found to be higher in patients with evidence of CMB presence, compared to patients without CMBs, while a higher risk for sICHafter IVT was also detected in patients with high CMB burden (>10 CMBs), when compared to patients with 0-10 or 1-10 CMBs on pre-treatment MRI. In the individual patient data meta-analysis, high CMB burden was associated with increased likelihood of sICH before and after adjusting for potential confounders. (more…)
Author Interviews, BMJ, Heart Disease, Social Issues, Stroke / 20.04.2016 Interview with: Nicole Valtorta NIHR Doctoral Research Fellow Department of Health Sciences University of York, UK Medical Research: What is the background for this study? What are the main findings? Response: Lonely and socially isolated adults are at increased risk of mortality. The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear. We systematically reviewed the evidence from prospective cohort studies to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke. We identified 23 papers reporting data from 16 longitudinal datasets, for a total of 4,628 CHD and 3,002 stroke events. Reports of eleven studies (CHD) and eight studies (stroke) provided data suitable for meta-analyses, the results of which indicated that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. People who were lonely or isolated had, on average, a 29% greater risk of incident CHD; similarly, the risk of developing stroke was 32% greater among isolated individuals. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Stroke / 06.04.2016 Interview with: Kazuomi Kario, MD, PhD, FACP, FACC, FAHA, FESC Professor, Chairman Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine (JMU) JMU Center of Excellence, Cardiovascular Research and Development (JCARD) Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London UK What is the background for this study? What are the main findings? Dr. Kario: The relationship between out-of-office blood pressure (BP), such as ambulatory BP and home BP, and cardiovascular events has been investigated in several studies. However, there is insufficient evidence as yet regarding which BP measurement predicts coronary artery disease (CAD) events most strongly. The HONEST Study is the largest prospective observational study in the world, which enrolled >20,000 hypertensive patients. The study observed cardiovascular events, monitoring both clinic BP and home BP on treatment of antihypertensive agent. The present analysis shows that home BP measured in morning (morning home BP) is a strong predictor of both CAD and stroke events in future, and may be superior to clinic BP in this regard. Furthermore, there does not appear to be a J-curve in the relationship between morning home BP and CAD or stroke events. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Stroke / 04.03.2016 Interview with: Hakan Ay MD, FAHA Associate Professor of Neurology and Radiology Stroke Service, Department of Neurology Director of Stroke Research, A.A. Martinos Center, Department of Radiology Massachusetts General Hospital Harvard Medical School Boston MA, USA Medical Research: What is the background for this study? What are the main findings? Dr. Ay: Recurrent stroke is an important public health problem. One quarter of all strokes are recurrent strokes. Approximately one out of every 10 patients with stroke develops a second stroke within the next 2 years. The most critical period for recurrence after stroke is the first 90 days; approximately half of recurrent strokes that occur within 2 years occur within the first 90 days. The RRE tool was developed at the Massachusetts General Hospital in 2010 to assess the 90-day risk of recurrent stroke. The RRE was subsequently tested in a separate cohort of patients with transient stroke symptoms (mini strokes) admitted to the Massachusetts General Hospital in 2011. The current study expands upon prior two studies by showing that the RRE tool provides reliable risk estimates when tested in cohorts of patients recruited from different academic centers in various parts of the world. The study reports that the RRE can stratify approximately one-half of patients with stroke either at high-risk or at low-risk with a reasonable accuracy. (more…)
Author Interviews, Neurological Disorders, Stroke / 29.02.2016 Interview with: Georgios Tsivgoulis , M.D., Ph.D., MSc, FESO Assistant Professor of Neurology University of Athens, Athens, Greece Visiting Associate Professor of Neurology Director of Stroke Research Department of Neurology University of Tennessee Health Science Center Medical Research: What is the background for this study? What are the main findings? Dr. Tsivgoulis: Literature data suggest that taking statins before an acute ischemic stroke may improve early outcomes including early neurological deterioration, mortality and disability in patients with acute ischemic stroke. However,the potential beneficial effect of statin pretreatment has never been investigated in acute ischemic stroke due to large artery atherosclerosis. The research question in this specific subgroup of ischemic stroke patients is of great importance, as large-artery atherosclerotic stroke carries the highest risk of early recurrent stroke in comparison to other acute ischemic stroke subtypes. Using prospectively collected data from over 516 consecutive patients with acute large-artery atherosclerotic stroke from seven tertiary-care stroke centers during a three-year period we found that statin pretreatment in patients with acute large-artery atherosclerotic stroke is associated with better early outcomes in terms of neurological improvement, disability, survival and stroke recurrence. (more…)
Author Interviews, Compliance, Neurological Disorders, Stroke / 23.02.2016 Interview with: Dr-William-Patrick-Neil William P. Neil, MD Vascular Neurologist SCPMG Regional Stroke Champion Neurology    Medical Research: What is the background for this study? Dr. Neil: Stroke survivors are less likely to have a recurrent stroke, or other complications if they take their medications as prescribed by their doctor. Mail order pharmacies are increasingly being used to deliver medications for a variety of diseases, and their use is associated with better medication adherence.  We wanted to see whether stroke patients who use mail-order pharmacies were more likely to have good medication adherence than those who used  local pharmacies. Medical Research: What are the main findings? Dr. Neil: We looked through a large electronic medical database in California, and found a total of 48,746 people discharged from the hospital with a stroke, and who also filled either a cholesterol medication or an anticoagulant (blood thinner). Of these, 136,722 refills were from a local pharmacy and 68,363 were by mail. Overall, patients were adherent to the medications 46.5% of the time if they picked up the medication from the pharmacy and 74% of the time if they had prescriptions mailed to them. (more…)
Author Interviews, Heart Disease, Stroke / 22.02.2016 Interview with: Dr. Rolf Wachter Head Senior physician University of Goettingen Göttingen, Germany Medical Research: What is the background for this study? What are the main findings? Dr. Wachter: Atrial Fibrillation is a known risk factor for stroke, and in stroke patients, it is a strong predictor of adverse outcome, if it is not adequately treated (e.g. by anticoagulation). However, in its paroxysmal form, Atrial Fibrillation (AF) may escape routine diagnostics. We aimed to show that we can increase the number of patients with detected AF if we do more monitoring for atrial fibrillation. As a unique feature of our study, we did not focus on a certain stroke subtype (i.e. cryptogenic stroke), but we aimed to consider all patients >= 60 years in whom the detection of  Atrial Fibrillation has a clinical relevance. The main finding of our study was that enhanced and prolonged Holter ECG monitoring (3x10 days of monitoring, analysed in a dedicated core lab) tripled the number of detected AF cases (from 4.5 to 13.5 %). 11 patients had to undergo enhanced and prolonged monitoring to find one additional case of Atrial Fibrillation. (more…)