Strokes More Common With Retinal Condition

By Crystal Phend, Senior Staff Writer, MedPage Today

Stroke risk roughly doubles with retinal vein occlusion, but the risk of myocardial infarction did not appear higher, according to a retrospective analysis of a claims database.
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The Best Part of Waking Up Also Lowers Stroke Risk

By Crystal Phend, Senior Staff Writer, MedPage Today

Women who start their day with a cup of coffee may be protecting themselves from stroke, according to a Swedish prospective cohort study.

Among 34,670 women, those who reported drinking at least one cup a day at baseline had a 24% reduction in stroke risk (95% CI 0.66 to 0.88) over a decade, Susanna C. Larsson, PhD, of the Karolinska Institute in Stockholm, and colleagues found.

"Given that coffee is one of the most popular beverages consumed worldwide, even small health effects of substances in coffee may have large public health consequences," they wrote online in Stroke: Journal of the American Heart

Strokes, Eye Disorder May Go Hand in Hand

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By Crystal Phend, Senior Staff Writer, MedPage Today

Hemorrhagic stroke appears more likely with advanced age-related macular degeneration (AMD), perhaps because of common underlying risk factors, a population-based study showed.

Stage 4 AMD independently predicted a 1.56-times greater risk of any type of stroke among older adults after adjustment for age, sex, and other key risk factors (95% confidence interval 1.08 to 2.26), Renske G. Wieberdink, MD, of Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues reported.

Hemorrhagic stroke risk was significantly higher -- nearly seven-fold -- in older adults with stage 4 AMD than in those who did not have AMD in the analysis presented at the American Stroke Association's International Stroke Conference.
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Early BP Lowering No Help in Acute Stroke

By Crystal Phend, Senior Staff Writer, MedPage Today

Lowering blood pressure early during acute stroke did nothing to improve outcomes and may actually impair patients' ability to live independently later on, researchers affirmed in a randomized trial.

Candesartan (Atacand) started within 30 hours of stroke onset and given over seven days did not affect the combined six-month rate of death from vascular causes, myocardial infarction, or stroke compared with placebo (11.7% versus 11.3%, adjusted hazard ratio 1.09, P=0.52), Eivind Berge, MD, of Oslo University Hospital Ullevål, and colleagues found.

Functional disability was 17% more common with the drug (P=0.048), the group reported here at the American Stroke Association's International Stroke Conference and simultaneously online in The Lancet.
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Cost Keeps Stroke Meds Out of Reach for Some

By Todd Neale, Staff Writer, MedPage Today

Some stroke survivors skip prescribed medications because the cost is too high -- a situation that may be worsening, particularly among young and uninsured patients, researchers found.
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Maternal Stroke History Tied to MI Risk in Women

By Todd Neale, Staff Writer, MedPage Today

A family history of stroke -- especially among female relatives -- may help predict the risk of acute coronary syndromes in women, a large prospective study found.
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Caregiving Strain and Estimated Risk for Stroke and Coronary Heart Disease Among Spouse Caregivers – Journal Article

High caregiving stress has been associated with poor physical and psychological health, and with increased mortality among spouse caregivers. This study examined the differential effects of stress on stroke and coronary heart disease (CHD) risk by race and sex. Caregiving strain was significantly associated with higher estimated risk for men, particularly African American men, providing caregiving to their wives.

Journal Article

Fish May Explain Notches in Stroke Belt

By Todd Neale, Staff Writer, MedPage Today

Differences in fish consumption may help explain the existence of the so-called Stroke Belt covering eight states in the southeastern U.S., a cross-sectional study showed.

Residents of those states ate fewer servings of fish overall (2.01 versus a national average of 2.11 per week), and when they do consume fish, it is most often fried (0.68 servings of fried fish versus 0.62 servings nationwide per week), Fadi Nahab, MD, of Emory University in Atlanta, and colleagues reported online ahead of the Jan. 11 print issue of Neurology.

Living in the Stroke Belt -- which includes North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana -- was independently associated with eating less than the recommended minimum of two servings of nonfried fish per week, even after adjustment for potential confounders (OR 1.32, 95% CI 1.17 to 1.50).
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Living Longer Comes With a Physical Cost - NYTimes.com

Image via CrunchBaseBy NICHOLAS BAKALAR

Americans are living longer, but those added years are more likely to be a time of disease and disability.

An analysis of government data has found that while life expectancy has steadily increased over the past decade, the prevalence of heart disease, stroke, cancer and diabetes has also increased, and disability has grown as well.

For example, in 1998 about 16 percent of men in their 70s had a mobility problem — that is, they failed one of four commonly used physical tests. By 2006, almost 25 percent failed at least one.

Writing in the January issue of The Journal of Gerontology B, the authors conclude that people live longer not because they are less likely to get sick, but because they survive longer with disease.
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World Stroke Day --- October 29, 2010

Image via Wikipediaby the CDC

October 29 is World Stroke Day 2010. Stroke is the third leading cause of death in the United States (1). Approximately 795,000 strokes occur annually in the United States, with an estimated cost of more than $73 billion (1). The theme for this year's World Stroke Day is "One in Six," to raise awareness that one in six persons worldwide will have a stroke in their lifetime, and that every 6 seconds, someone somewhere will die from a stroke (2,3).

This campaign stresses that the occurrence of stroke is common and widespread, but that stroke can be prevented and stroke survivors can recover and regain their quality of life with care and support. The campaign recommends the following six actions to reduce the likelihood of having a stroke:

• Know your personal risk factors, including diagnosed high blood pressure, diabetes, or high cholesterol.
• Be physically active and exercise regularly.
• Avoid obesity by eating a healthy diet with lots of fresh fruits and vegetables.
• Limit alcohol consumption.
• Avoid cigarette smoke. People who smoke should seek help to stop now.
• Learn to recognize the warning signs of a stroke and call 9-1-1 right away if someone is suspected of having a stroke.

CDC addresses stroke prevention through state-based programs to prevent heart disease and stroke, through the Paul Coverdell National Acute Stroke Registry, and through many other partnerships. Information about stroke and stroke prevention is available at http://www.cdc.gov/stroke, and additional information about World Stroke Day 2010 is available at http://www.worldstrokecampaign.org/pages/home.aspx. 

References

1. Lloyd-Jones D, Adams R, Brown TM, et al. Heart disease and stroke statistics 2010 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2010;121:e46--215.
2. Seshadri S, Beiser A, Kelly-Hayes M, et al. The lifetime risk of stroke: estimates from the Framingham Study. Stroke 2006;37:345--50.
3. World Health Organization. The atlas of heart disease and stroke. Geneva, Switzerland: World Health Organization; 2004.

Music Therapy Has Some Benefits in Stroke Recovery from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Two small clinical trials found that one type of music therapy -- rhythmic auditory stimulation -- improved gait in patients who had suffered a recent stroke, according to a Cochrane review.

The two randomized trials, involving 98 stroke patients, showed that gait velocity, cadence, and symmetry, as well as stride length, were all improved with the therapy, according to Joke Bradt, PhD, a board-certified music therapist at Temple University in Philadelphia, and colleagues.

"These results are encouraging," they wrote in the Cochrane review, "but more randomized controlled trials are needed before recommendations can be made for clinical practice."
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Testosterone Gel Linked to Risk of MI and Stroke from MedPage Today

By Joyce Frieden, News Editor, MedPage Today

Applying topical testosterone appears to raise the risk of cardiovascular events including myocardial infarction, atrial fibrillation, and stroke in older men with limited mobility, a study has found.

Compared with men who had lower levels of circulating testosterone, men with testosterone levels in the highest quartile more than doubled their risk of cardiovascular events, (HR 2.4; P=0.05), wrote Shalender Bhasin, MD, of Boston University, and colleagues in a study published online June 30 by the New England Journal of Medicine.

"Testosterone gel ... was associated with a greater frequency of adverse events, particularly cardiovascular, respiratory, and dermatologic events," the authors wrote. "The divergence between the [testosterone gel and placebo gel] groups in the incidence of cardiovascular adverse events was maintained over the six-month intervention period and did not diminish during the three-month observation phase that followed the intervention period."

The pattern of adverse cardiovascular events associated with testosterone therapy was considered by the data and safety monitoring board to be of sufficient concern to warrant termination of the trial before the target number of 252 patients had been enrolled.

Testosterone did, however, increase strength and improve mobility -- the primary endpoint of the trial. The men randomized to transdermal testosterone improved leg and chest press strength and improved stair-climbing power while carrying a load compared with controls.

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Medical News: Evidence-Based Treatment Improves Older Stroke Victims' Chances - in Cardiovascular, Strokes from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Older stroke patients remain at higher risk for adverse outcomes than younger ones, but the gap has narrowed with wider implementation of evidence-based guidelines, researchers say.

More than 10% of stroke patients over 80 died in the hospital, compared with 3% of those under age 50, Gregg C. Fonarow, MD, of the University of California Los Angeles, and colleagues reported online in Circulation.

But overall use of guideline-recommended therapies improved substantially in older patients from 2003 to 2009, particularly for patients over 90, they said.

During that time, several hospitals and stroke centers have adopted "Get with the Guidelines," an intervention to apply evidence-based guidelines to care. Adopters have seen "substantial improvements ... in performance measures for ischemic stroke patients, including pharmacological and nonpharmacological management in each age group," the researchers wrote.
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Robots May Aid Stroke Recovery from MedPage Today

By Todd Neale, Staff Writer, MedPage Today
Robot-assisted rehabilitation resulted in some improvements in motor function and quality of life for patients with chronic disability following stroke, a randomized trial showed.

Significant gains in both basic motor function (P=0.02) and the time to complete everyday tasks (P=0.005) were observed in the robot-assisted group at 36 weeks compared with usual care, the researchers reported online in the New England Journal of Medicine.

This despite the fact that on the primary endpoint -- determined at 12 weeks, immediately after rehabilitation ended -- motor function was not significantly improved in the robot-assisted group, according to Albert Lo, MD, PhD, of the Providence Veterans Affairs Medical Center in Rhode Island, and colleagues.

The findings "provide evidence of potential long-term benefits of rehabilitation and challenge the widely held clinical belief that gains in motor function are not possible for long-term stroke survivors," Lo and his colleagues wrote.
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Smoking May Cancel Stroke Benefit of Drinking - from MedPage Today

By Michael Smith, North American Correspondent, MedPage Today

Moderate drinking may protect against stroke, but not if the drinker is also a smoker.

An analysis of stroke incidence in a long-running cohort study showed that both nondrinkers and heavier drinkers were at higher risk than moderate drinkers, according to Yangmei Li, a PhD candidate at Cambridge University.

That effect -- known as a U-shaped curve -- has been seen in some studies but not in others, Li told reporters at the annual meeting here of the American Academy of Neurology.

The reason, she said, may be the impact of smoking.

She and colleagues looked at data from the European Prospective Investigation into Cancer (Norfolk) study, which also included information on cardiovascular outcomes.

Volunteers ages 39 through 79 began taking part in the study between 1993 and 1997. At baseline, they were free of heart attack, stroke, and cancer and were followed up for incident stroke until 2008.

All told, the researchers looked at the relationship between alcohol and stroke in 10,171 men and 12,353 women.

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Apnea Boosts Stroke Risk in Men from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Severe obstructive sleep apnea almost tripled stroke risk in men, data from a prospective cohort study showed.

Among men with mild or moderate apnea, each one-unit increase in the obstructive apnea hypopnea index (OAHI) raised stroke risk by 6%. Obstructive sleep apnea did not have a significant association with stroke risk in women, investigators reported online in the American Journal of Respiratory and Critical Care Medicine.

"This study provides compelling evidence based on eight years of prospective data from a large, geographically diverse community-based cohort of middle-age and older adults that modest to severe levels of sleep apnea increase risk of stroke in men, suggesting the need to evaluate the role of sleep apnea treatment in ameliorating stroke risk," Susan Redline, MD, of Case Western Reserve University in Cleveland, and colleagues concluded.

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BP Variation Predicts Stroke Better than Mean Values - from MedPage Today

By John Gever, Senior Editor, MedPage Today

Blood pressure variability over time, not merely its average level, is a powerful risk factor for stroke, myocardial infarction, and other cardiovascular events, researchers said.

Moreover, some antihypertensive drugs are better than others at controlling blood pressure variability, according to three new reports in the Lancet journals, all by Peter M. Rothwell, MD, PhD, of John Radcliffe Hospital in Oxford, England, and colleagues.

The researchers reported that:
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High Fat Intake Ups Stroke Risk in Older Women - in Meeting Coverage, ASA from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Postmenopausal women who eat the most fat have an elevated risk of ischemic stroke, researchers found.

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ASA: Coffee Drinkers Have Lower Stroke Risk - in Meeting Coverage, ASA from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Drinking just one cup of coffee a day -- either regular or decaffeinated -- was associated with a 30% reduced risk of stroke, a large, prospective study showed.

Greater consumption did not heighten the apparent protective effect, according to Yangmei Li, MPhil, of the University of Cambridge in England.

The results, gathered over a mean 12-year follow-up, were not affected by adjusting for several known stroke risk factors, Li reported at the American Stroke Association meeting.
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Medical News: Evidence-Based Treatment Improves Older Stroke Victims' Chances - in Cardiovascular, Strokes from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Older stroke patients remain at higher risk for adverse outcomes than younger ones, but the gap has narrowed with wider implementation of evidence-based guidelines, researchers say.

More than 10% of stroke patients over 80 died in the hospital, compared with 3% of those under age 50, Gregg C. Fonarow, MD, of the University of California Los Angeles, and colleagues reported online in Circulation.

But overall use of guideline-recommended therapies improved substantially in older patients from 2003 to 2009, particularly for patients over 90, they said.

During that time, several hospitals and stroke centers have adopted "Get with the Guidelines," an intervention to apply evidence-based guidelines to care. Adopters have seen "substantial improvements ... in performance measures for ischemic stroke patients, including pharmacological and nonpharmacological management in each age group," the researchers wrote.
Continue Reading