Stroke risk

Metabolic Syndrome and Stroke Risk

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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

This online calculator can predict your stroke risk

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

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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coronary heart disease, compared to working 35 to 40 hours weekly, in the analysis of published and previously unpublished prospective cohort studies from the U.S., Europe, and Australia.”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.

Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today

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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).

Safety Alerts – Pradaxa dabigatran – Lower Risk for Stroke and Death, but Higher Risk for GI Bleeding Compared to Warfarin

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Safety Alerts for Human Medical Products > Pradaxa dabigatran: Drug Safety Communication – Lower Risk for Stroke and Death, but Higher Risk for GI Bleeding Compared to Warfarin.

ISSUE: The FDA recently completed a new study in Medicare patients comparing Pradaxa to warfarin, for risk of ischemic or clot-related stroke,  bleeding in the brain, major gastrointestinal (GI) bleeding, myocardial infarction (MI), and death. The new study included information from more than 134,000 Medicare patients, 65 years or older, and found that among new users of blood-thinning drugs, Pradaxa was associated with a lower risk of clot-related strokes, bleeding in the brain, and death, than warfarin. The study also found an increased risk of major gastrointestinal bleeding with use of Pradaxa as compared to warfarin. The MI risk was similar for the two drugs.

Importantly, the new study is based on a much larger and older patient population than those used in FDA’s earlier review of post-market data, and employed a more sophisticated analytical method to capture and analyze the events of concern. This study’s findings, except with regard to MI, are consistent with the clinical trial results that provided the basis for Pradaxa’s approval. As a result of these latest findings, the FDA still considers Pradaxa to have a favorable benefit to risk profile and have made no changes to the current label or recommendations for use.

Daily Aspirin – Yes or No?

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Aspirin: FDA Says ‘No’ Others Say ‘Yes’.

I found this article quite helpful in my own decision regarding whether or not to continue my daily aspirin 81 mg dose.

The bump I gave myself on the shin a few weeks ago that bled profusely and took hours to clot was also quite helpful in my decision regarding whether or not to continue my daily aspirin 81 mg dose. 

Update 06.06.14

Check out the following link.  If you’re an older male you might find this of interest.

http://www.webmd.com/erectile-dysfunction/news/20110303/regular-use-of-painkillers-linked-to-ed

Update 07.26.14

This link takes you to the 2012 Circulation article.

Aspirin.

Update 08.04.14

More links for your reading and research pleasure.

Aspirin May Not Protect Against Cardiovascular Disease – Prevention.com.

Benefits of aspirin more modest than previously believed — St George’s, University of London.

Researchers from Professor Kausik Ray’s group at St George’s, University of London investigated the drug’s effectiveness in primary prevention and the prevalence of side effects. They also assessed if aspirin had any impact on the risk of death from cancer among people considered at risk of cardiovascular disease.

They analysed data from nine clinical trials involving over 100,000 participants without a history of cardiovascular disease. Half of the participants took aspirin and half took a placebo. The average participant in the aspirin arm of these trials took aspirin for about six years.

The researchers found that although aspirin in conventional daily or alternate day doses reduced the risk of total cardiovascular disease events by 10 per cent, this was largely due to a reduction in non-fatal heart attacks. It did not include a reduction in other cardiovascular disease events including death from heart attack, or fatal or non-fatal stroke.

The study also showed that this benefit was almost entirely offset by a 30 per cent increase in risk of life-threatening or debilitating internal bleeding events. This means that while one cardiovascular disease event was averted for every 120 people treated with aspirin for about six years, one in 73 people suffered from potentially significant bleeding during the same period.

Sleep Apnea Linked to Cancer

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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.