The incidence of TIA in the United States is estimated to be 200,000-500,000 per year, with a prevalence of 5 million individuals, but is likely underreported.2 Stroke is preceded by TIA in 12-30% of patients and is the 5th leading cause of death in the US, contributing significantly to long term disability.2,3 Strokes occur more commonly in men than women, but women experience more severe morbidity.2,3 Stroke prevalence increases with age and occurs more frequently in black and Hispanic populations.3 It should also be noted that 90% of strokes worldwide occur in the setting of potentially modifiable risk factors which presents an incredible opportunity for early intervention, especially following TIA.2TIA: Emergency Department Evaluation and Disposition — http://www.emdocs.net/tia-emergency-department-evaluation-and-disposition/?utm_source=feedly&utm_medium=rss&utm_campaign=tia-emergency-department-evaluation-and-disposition
Statins Can Save Lives
They examined the records of nearly 300,000 adults in the U.S. who had an initial atherosclerotic cardiovascular disease event between 2007 and 2016. These were divided into three groups: coronary heart disease, ischemic stroke or transient ischemic attack, or peripheral artery disease.
When people left the hospital or emergency department in 2007 following a first diagnosis in one of these categories, about half began taking statins within 30 days. By 2016, statin use increased to approximately 60%.
“Based on the guidelines, we hoped to see a much higher uptake among this entire group,” says Dr. Noseworthy. “Statin intolerance was only noted for 4%-5% of the patients, which means as many as 35% of patients are not receiving treatment according to the guidelines.”Mayo Clinic. “Statins can save lives; are they being used?.” ScienceDaily. http://www.sciencedaily.com/releases/2020/12/201201144030.htm (accessed December 2, 2020) — https://www.sciencedaily.com/releases/2020/12/201201144030.htm
Xiaoxi Yao, Nilay D. Shah, Bernard J. Gersh, Francisco Lopez-Jimenez, Peter A. Noseworthy. Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016. JAMA Network Open, 2020; 3 (11): e2025505 DOI: 10.1001/jamanetworkopen.2020.25505
Metabolic Syndrome and Stroke Risk
To evaluate the association between ischemic stroke and metabolic syndrome, DeBoer and Gurka reviewed more than 13,000 participants in prior studies and their stroke outcomes. Among that group, there were 709 ischemic strokes over a mean period of 18.6 years assessed in the studies. (Ischemic strokes are caused when blood flow to the brain is obstructed by blood clots or clogged arteries. Hemorrhagic strokes, on the other hand, are caused when blood vessels rupture.)
DeBoer developed the scoring tool, an online calculator to assess the severity of metabolic syndrome, with Matthew J. Gurka, PhD, of the Department of Health Outcomes and Biomedical Informatics at the University of Florida, Gainesville. The tool is available for free at https://metscalc.org/.
Journal Reference: Mark D. DeBoer, Stephanie L. Filipp, Mario Sims, Solomon K. Musani, Matthew J. Gurka. Risk of Ischemic Stroke Increases Over the Spectrum of Metabolic Syndrome Severity. Stroke, 2020; 51 (8): 2548 DOI: 10.1161/STROKEAHA.120.028944
Presented with the following caveat:
I tried the calculator but I’m not quite sure how useful it will be in clinical settings. As far as insurance underwriting is concerned I probably won’t use it.
Stroke Rounds: Long Work Hours, Stroke and CHD Risk Associated | Medpage Today
via Stroke Rounds: Long Work Hours, Stroke and CHD Risk Associated | Medpage Today.
“Working 55 hours or more a week was associated with significant 33% increase in stroke risk and a more modest 13% increase in risk of developing coronary heart disease, compared to working 35 to 40 hours weekly, in the analysis of published and previously unpublished prospective cohort studies from the U.S., Europe, and Australia.”
One could argue for causation given the strength of association identified by this study. Common sense tells us that anyone working more than 60 hours a week is going to have considerably less time for other activities like exercise and time with family and friends. Long hours working also can lead to neglect of one’s health.
Obstructive Sleep Apnea, Atrial Fibrillation, and Stroke | Physician’s Weekly
Researchers in Connecticut have found that obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) appears to be an independent predictor of stroke.
via Obstructive Sleep Apnea, Atrial Fibrillation, and Stroke | Physician’s Weekly.
Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today
Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today.
Compared with OSA-negative patients, untreated OSA was associated with an 86% higher mortality risk (adjusted hazard ratio 1.86, 95% CI 1.81 to 1.91), and treated OSA was associated with a 35% higher mortality risk (aHR 1.35, 95% CI 1.21 to 1.51), wrote Miklos Z. Molnar, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues, in the journal Thorax.
Untreated OSA also was associated with a 3.5 times higher risk of incident coronary heart disease (aHR 3.54, 95% CI 3.40 to 3.69), and a 3.5 times higher risk of incident strokes (aHR 3.48, 95% CI 3.28 to 3.64), while treated OSA was associated with a threefold higher risk of incident CHD (aHR 3.06, 95% CI 2.62 to 3.56) and 3.5-fold higher risk of incident strokes (aHR 3.50, 95% CI 2.92 to 4.19). The risk of incident kidney disease also was significantly higher in untreated (aHR 2.27, 95% CI 2.19 to 2.36) and treated OSA (aHR 2.79, 95% CI 2.48 to 3.13).
ASCVD Risk Estimator
Sleep Apnea Linked to Cancer
Moderate-to-severe OSA was associated with a 2.5-fold higher likelihood of incident cancer (95% CI 1.2-5.0) after adjustment for obesity and a full range of other factors, Nathaniel Marshall, PhD, of the University of Sydney Nursing School in Australia, and colleagues found.
Cancer mortality was 3.4 times more common (95% CI 1.1-10.2) in those with sleep apnea than with no sleep apnea during 20 years of follow-up, they reported in the April 15 issue of theJournal of Clinical Sleep Medicine.
Testosterone Treatment Tied to Worse Cardiac Outcomes
After adjustment for the presence of coronary artery disease, testosterone therapy was associated with a greater risk of all-cause mortality, myocardial infarction, and ischemic stroke 3 years after angiography (25.7% versus 19.9%; HR 1.29, 95% CI 1.04-1.58), according to P. Michael Ho, MD, PhD, of the Department of Veterans Affairs (VA) Eastern Colorado Health Care System in Denver, and colleagues.
via Testosterone Tx Tied to Worse Cardiac Outcomes.
How come the television commercials don’t tell you this information when they try to make you think you have a disease called Low T?
Annual prescriptions for testosterone increased more than five-fold from 2000 to 2011. In 2011, the total number of prescriptions numbered 5.3 million and make up a market of 1.6 billion, the authors wrote.
Afib Linked to Silent Stroke
MRI indicated silent cerebral ischemia lesions in 89% patients with paroxysmal Afib and 92% with persistent Afib compared with 46% of controls, which wasn’t significantly different between the two types of Afib but was for both versus controls (P<0.01).
The number of these lesions averaged 41 in persistent Afib, 33 in paroxysmal Afib, and 12 in controls, which was significantly different for all three groups.
The high prevalence of these lesions in the control group compared with what has been reported in the general population may have reflected the moderate to high cardiovascular risk among these patients referred for cardiovascular prevention or treatment, the researchers suggested.
The lesions can have either ischemic and embolic origins, but the peculiar “spotted” distribution of “small sharply demarcated lesions, often in cluster, with bilateral distribution, prevalently in the frontal lobe” seen in 50% and 67% of the paroxysmal and persistent Afib patients, respectively, strongly supported an embolic mechanism, they noted.
via Afib Linked to Silent Stroke.
If these findings are replicated in future studies, the question for underwriters is should any Afib risk be Standard mortality?
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