XVII. European Stroke Conference
Nice, France

Oral Session:

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 8:30 - 8:40 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

01
Risk factors for cerebral infarction, a study of 66 610 patients reported to the Swedish National Quality Register for Stroke Care (Riks-Stroke)
S. Åsberg    K. Henriksson    B. Farahmand    K. Asplund    B. Norrving    B. Stegmayr    P.O.Wester    K. Hulter Åsberg    A. Terént       
 

The Stroke Unit at Uppsala University Hospital

SWEDEN

Background: Atrial fibrillation (AF), hypertension (HT), diabetes mellitus (DM) and smoking are risk factors associated with cerebral infarction (CI). We investigated the frequency of these risk factors among stroke patients in comparison with the general Swedish population. Method: From 2001 to 2005, 66 610 patients with a first-ever CI were registered in the Swedish National Quality Register for Stroke Care (RS). The patients were divided into four age groups (<65, 65-74, 75-84, and >/=85 years). Temporal trends for the frequency of AF, DM, HAT and smoking were analysed by logistic regression. Comparative data from the Swedish population were retrieved from Statistics Sweden and the National Board of Health and Welfare. Results: During the study period, the frequency of AF, among stroke patients significantly increased from 25.1% to 27.3%. The trend was most marked in the youngest male age group and in the oldest patients of both sexes. Treatment of HAT increased significantly from 42.8% to 51.2%. The trend was strongest in the oldest age group. Similar trends were seen in the Swedish population. Approximately 20% had DM, but no significant temporal trend was found. Smoking habits significantly decreased in men but did not change among women. In the youngest age group, 36.4% of the stroke patients were smokers, compared with 22.2% in the Swedish population. Discussion: Conventional cardiovascular risk factors remain major determinants of stroke. The relative importance of individual risk factors is changing over time with increasing contribution of atrial fibrillation and hypertension and decreasing contribution of smoking in men. The prospects for better primary prevention of stroke are evident.

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 8:40 - 8:50 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

02
THERAPEUTIC INTERVENTIONS AND SUCCESS IN RISK FACTOR CONTROL FOR SECONDARY PREVENTION OF STROKE
J. Alvarez-Sabin    M. Quintana    M.A.Hernandez-Presa    C. Alvarez    J. Chaves    M. Ribo                            
 

Unitat Neurovascular Vall d'Hebron

SPAIN

Aim We aim to study the actual achievement of preventive therapeutic goals in daily clinical practice in ischemic stroke (IS) compared to coronary artery disease (CAD) patients Methods Observational multicentric case/control study (3-IS/ 1-CAD) performed in 1444 primary health centers in Spain. Different therapeutic objectives following the American Heart Association recommendations were predefined. Demographic, risk factor data and success or failure in the achievement of these objectives were recorded Results 5458 patients were studied: 4098 (75.1%) had suffered IS and 1360 (24.9%) CAD. Despite that >90% of patients with hypertension, diabetes or dyslipidemia were under specific drug regimens <25% achieved the desired therapeutic objective for each risk factor. Achievement of therapeutic objectives according to the different risk factors was generally poor, especially among IS patients: hypertension (23.8% Vs 27.2%; p=0.028); dyslipidemia (13.6% Vs 20.3%; p<0.001) and obesity (49.1% Vs 54.6%; p=0.002) were less frequently controlled among IS patients. The only objective widely achieved was antithrombotic drug use in patients with atrial fibrillation (97.2% II vs 94.7% CI, p=0.125). Only 3.3% of IS patients had all risk factors under control Vs 5.6% of CAD(p=0.006). For all patients, a multivariate logistic regression model showed that independent predictors of full risk factor control were: suffering CAD as compared to IS (OR 2.1151 (1.357- 3,296); p=0.001), older age (OR 1.021 (1.002-1.040);p=0.028) and having <3 risk factors (OR:16,986 (9,023-31,977);p<0.001). Conclusions Actual achievement of preventive therapeutic objectives for secondary prevention of vascular events is clearly insufficient, especially among stroke patients. Strategies addressed to improve risk factor control are urged.

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 8:50 - 9:00 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

03
C-reactive protein as a marker of first-ever ischemic stroke and intracerebral hemorrhage. A prospective nested case-referent study.
J. Andersson                                                               
 

Umeå University

SWEDEN

Background and Purpose High sensitive c-reactive protein (hsCRP) is a determinant of stroke but there are few prospective studies on hsCRP and subtypes of ischemic stroke and intracerebral hemorrhage (ICH). Our primary aim was to study hsCRP as a determinant for ischemic stroke classified according to TOAST criterion and ICH in a prospective study. A secondary aim was to study the relationship between the 1444C>T polymorphism, plasma levels of CRP and stroke. Methods The study was a prospective population based case-referent study nested within the Northern Sweden Cohorts. We defined 308 ischemic stroke and 61 ICH cases. Ischemic stroke was classified according to TOAST criteria. Two controls for each case were defined from the same cohort. Results Time from screening to the ischemic stroke event was on average 52 months (0.2 to 141 months) and to the ICH event 50 months (0.5 to 124). The highest (>3 mg/L) vs. lowest group (<1mg/L) of hsCRP at screening was associated with ischemic stroke, OR 2.58 (1.74-3.84), but not with ICH, OR 1.63 (0.67-3.93). In a multivariate model including traditional risk factors hsCRP remained associated with ischemic stroke OR 2.06 (1.29-3.29). In the multivariate model significant association for the subtypes of ischemic stroke and hsCRP could only be demonstrated for small vessel disease OR 3.88 (1.10-13.7). The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of hsCRP but neither with ischemic stroke nor ICH. Conclusions This prospective population based study showed that hsCRP was significantly associated with the risk of having a first ischemic stroke, especially for small vessel disease, but not for ICH. No significant associations were found between the CRP 1444C>T polymorphism and any stroke subtype.

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 9:00 - 9:10 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

04
Knowledge of stroke risk factors and warning signs in the older general population
A. Hickey    A. O'Hanlon    H. McGee    E. Shelley    F. Horgan    D. O'Neill                            
 

Royal College of Surgeons in Ireland

IRELAND

Background: General population awareness of risk factors and warning signs for stroke are essential in prevention and rapid action to manage stroke. Knowledge among older people, who are most vulnerable to stroke, is particularly important. This study sought to identify the understanding of stroke risk factors and warning signs in older community-dwelling Irish adults. The relationship between knowledge and demographic variables, and the influence of personal risk factors (e.g., prior experience of stroke) was also examined. Methods: Randomly selected community based older people (age 65+)(n=2,033; 68% response) were interviewed in their own homes. Interviews included questions relating to participants’ knowledge of stroke risk factors and warning signs, and personal risk factors for stroke. Results: Of the overall sample, 6% had previously experienced a stroke or trans-ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly with warning signs, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those aged 75+, with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland). Discussion: This study suggests that many older adults may not recognize early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Levels of knowledge may differ across countries and sub-groups. Local evidence is needed to best address knowledge deficits. Overall, lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 9:10 - 9:20 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

05
Increased Incidence of Cervical Artery Dissection in the Cold Season
M.K.Kloss    C.L.Lichy    T.B.Brandt    C.G.Grond-Ginsbach    M.A.Arnold    S.E.Engelter                            
 

University Heidelberg

GERMANY

Background Recent infection and a proinflammatory diathesis are discussed to contribute to the risk for spontaneous cervical artery dissection (sCAD). Since morbidity due to respiratory infections is higher in the cold season, we tested the hypothesis of infection-triggered CAD by investigating the seasonal variability of sCAD incidence. Methods We analysed the date of symptom onset in all patients with sCAD consecutively diagnosed and treated in two academic centers located in the Rhine valley between 1995 and 2006. 211 patients with sCAD of the internal carotid artery (139 strokes, 25 TIAs, 47 with local signs only) and 84 with sCAD of the vertebral artery (70 strokes, 6 TIAs, 8 with local signs only) were identified. Mean age was 46.5 +/-5.7 years, 120 patients were females. CAD was confirmed by angiography or by fat suppressed MRI sequences, either. Patients with a relevant underlying trauma were excluded from analysis. We further performed a metaanalysis of our findings and those of a recent study from Switzerland with a similar design (n=361). Results SCAD incidence was highest during winter (n=84/295; 28.5%) ,and lowest during summer (n=62/295; 21.0%; p=0.06). Findings were consistent with those of the Swiss study. In the metaanalysis, incidence significantly varied between the four seasons (p=0.01) with a highly significant increase of hibernal (197/656) versus estival events (147/656; p= 0.0037) Discussion Our data from a region with uniform climatic conditions revealed an increased incidence of sCAD in the colder season. Together with similar findings from an independent population, this contributes to the perception of sCAD as a proinflammatory condition triggered by infections.

Risk factors of stroke
Date: Wednesday 14 May 2008  
Time: 9:20 - 9:30 -  Room: Calliope
Chair: J. Lodder, The Netherlands and K. Spengos, Greece

06
Effect of Tight Neckties on Cerebrovascular Reactivity
T.J.Quinn    M. Rafferty    J. Dawson    M.R.Walters                                          
 

Gardiner Institute, University of Glasgow

UNITED KINGDOM

Introduction:Neckties remain a popular fashion accessory. Theoretically, through compression of jugular venous system, a necktie may elevate intracranial venous pressure and impair cerebrovascular reactivity. Elevation of intra-occular pressures through this mechanism has been demonstrated previously. We hypothesised that wearing a tight necktie would alter cerebrovascular reactivity. Methods:A tight necktie was simulated using a novel, bespoke apparatus of pneumatic inner-tube with aneroid pressure gauge. Using a randomised crossover design, we quantified the effect of circumferential neck pressure on Breath Hold Index (BHI), a commonly used marker of cerebrovascular reactivity. The “pseudo-tie” was worn inflated or deflated for 5 minutes, to simulate tight and loose necktie respectively. Maximum inflation pressure was determined by participant’s subjective perception of a tight but comfortable pressure. BHI measurements were performed following removal of the pseudo-tie. Paired t-testing was used to compare BHI values with pseudo-tie inflated and deflated. Results:We enrolled 40 healthy male volunteers. Mean age 31.5 (SD 10.5) years. Mean inflation pressure for the tight pseudo-tie was 63.5(SD 12.3)mmHg. There was a reduction in cerebrovascular reactivity of 0.23 units when the pseudo-tie was worn tight (BHI loose 1.44 (SD 0.48); BHI tight 1.21 (SD 0.38) p<0.001). Conclusion:A statistically significant impairment in cerebrovascular reactivity was found when wearing our inflated pseudo-tie. However, mean BHI was still within a range of normal cerebrovascular reactivity. Any cerebrovascular effect of tight neckties in young healthy males is likely negligible. The situation may differ in older patients or those with vascular risk factors.