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  • 1
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    Baseline Serum Biomarkers of Inflammation and Subsequent Visit-to-Visit Blood Pressure Variability: A Post Hoc Analysis of MESA
    Oxford University Press (OUP) ; 2023
    In:  American Journal of Hypertension Vol. 36, No. 3 ( 2023-02-24), p. 144-147
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 36, No. 3 ( 2023-02-24), p. 144-147
    Abstract: Higher blood pressure variability (BPV) is associated with the development of major vascular diseases, independent of mean blood pressure. However, despite data indicating that serum inflammatory markers are linked to hypertension, the association between serum inflammatory markers and BPV has not been studied in humans. Methods This is a post hoc analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) study. The study exposure was tertiles of serum level of interleukin-6 (IL-6), C-reactive protein (CRP), d-dimer, plasmin–antiplasmin complex (PAP), fibrinogen antigen, and calibrated Factor VIII (%) at the baseline study visit. The primary outcome was visit-to-visit BPV measured as the residual standard deviation (rSD) of at least 4 study visits (2000–2018). Two logistic regression models were fit to the top tertile of rSD during follow-up: in Model 1, we adjusted for age, sex, and hypertension, and in Model 2, for patient age categories, sex, race/ethnicity, education, hypertension, diabetes, smoking, drinking, body mass index, lipid-lowering medication, and mean systolic blood pressure. Results Our analysis included 5,483 patients, with a mean (SD) age of 61.4 (10.0) years, 52.9% female, and 40.7% White. In unadjusted analyses, all markers of inflammation were associated with higher BPV, but after adjustment, only IL-6 retained significance (P & lt; 0.001). The odds ratio for the highest tertile of BPV and IL-6 was 1.49 (95% confidence interval [CI] 1.28–1.74, P & lt; 0.001). Conclusions Baseline serum IL-6 was associated with increased subsequent BPV in a large multiracial cohort. Further investigation is needed to better understand the relationship between chronic inflammation and BPV.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpac122
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1479505-X
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  • 2
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    Trends in American Indian/Alaskan Native Self-Reported Stroke Prevalence and Associated Modifiable Risk Factors in the United States from 2011-2021
    Elsevier BV ; 2024
    In:  Journal of Stroke and Cerebrovascular Diseases ( 2024-3), p. 107650-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, ( 2024-3), p. 107650-
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2024.107650
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2052957-0
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  • 3
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    Abstract TP306: Streamlining the Enrollment Process in Acute Stroke Trials: Perspective From a Comprehensive Stroke Center
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Introduction: Acute stroke is a stressful time for patients, families, and medical staff. Adding potential clinical trial enrollment to this mix further complicates the situation, and can result in chaos, delaying randomization or losing potential patients due to time constraints. Streamlining processes can decrease enrollment times and improve flow, compliance, and data quality. Methods: Our stroke research team developed multiple processes to improve acute trial enrollments. We developed an enrollment grid that details which trial to offer to patients who qualify for multiple acute trials, allowing us to equitably enroll in all trials without bias. We house enrollment binders in the emergency room with documents to be completed during enrollment, tabbed by research member (MD vs coordinator). These include the current consent form version with a cover sheet requiring the consenter to verify the latest version of the consent is being used and is accompanied by a study-specific script that includes all consent elements. This helps team members to uniformly present information, and not miss important elements due to stress and time constraints. This binder also includes protocol reminders, drug orders, and references to a secure share drive with additional helpful documents. We hold yearly consenting practice sessions for new fellows and research team members. We created electronic health record “smart phrases” including a consent process note and subsequent trial-specific documentation needs. Results: We analyzed 11 enrollments from 2 acute stroke trials that were enrolling between 1/1/16-1/1/18, split into two cohorts of pre- vs post-process implementation on 1/1/17. We found major improvement in our internal workflow and consistency while staying compliant with regulatory requirements. Times from patient arrival to signed consent decreased from 3.2±1.5 to 0.99±0.1 hrs (p 〈 0.005). Additionally, our overall data quality remained excellent with an error rate well below 〈 1%. Conclusion: Our new processes support our vision of efficient trial conduction in the acute setting with reduction of enrollment times and maintained excellent data quality. We are now implementing and disseminating these processes to our spokes and telestroke sites.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.TP306
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 4
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    Abstract P303: Research Process Development Mitigates Effect of COVID-19 on Stroke Trial Enrollment
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Introduction: With hundreds of thousands of clinical trial patients enrolled yearly, the COVID-19 pandemic caused a significant, unexpected disruption in clinical trials across the world. US data showed a 70% enrollment reduction in April and a 38% reduction in July 2020, compared to pre-pandemic rates. We implemented processes during the initial phase of the pandemic to minimize participant and staff viral exposure, develop remote procedures, and ease communication barriers, while still maintaining enrollment goals. Methods: Our stroke research team developed multiple processes to help mitigate pandemic effects on our enrollment. We developed watchlists for eligible and interested patients who could not be enrolled due to national and local restrictions. As research staff was unable to approach patients in person, phone and email scripts were developed to ensure information was disseminated in a consistent fashion. Remote and alternate consent methods were implemented. We tracked the evolving national and local guideline changes, and began re-opening trials on May 23, 2020. We implemented a rotating pool of coordinators, including a site-specific sanitation plan, once it was safe to be on campus in-person. In person meetings were moved to a virtual platform. Enrollment data across for 10 active subacute stroke studies, each active over the 3 years of, 2018-2020, was analyzed for the months from March to June, with 2020 individually compared to 2018 and 2019 via the Student T-Test. Results: Total enrollment during these 4 months were 15 participants in 2018, 11 in 2019, and 15 in 2020, with no statistical difference between the years. No study patients nor staff contracted symptoms of COVID-19. Conclusion: Enrollment shows no significant changes despite COVID-19. New processes allowed the timely reopening of clinical trials, an overall maintenance of enrollment rates, including a non-significant increase in 2020 compared to previous years. Our telehealth and virtual communication focused processes prioritize the safety of patients and staff while ensuring quality control and appropriate enrollment numbers.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P303
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 5
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    Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP218
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Abstract WP405: Ultra-short-term Blood Pressure Variability is Increased in Ischemic Stroke Patients Compared to Controls
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Introduction: Systolic blood pressure variability (BPV) is increased after ischemic stroke and higher levels are associated with worse outcome. Accurate quantification of BPV requires frequent measurement, which is not practical with conventional sphygmomanometry. Finger photo-plethysmography allows non-invasive continuous blood pressure measurement and has been validated against invasive measurement techniques. Hypothesis: Ultra-short-term BPV (uBPV) will be higher in patients with recent ischemic stroke compared to controls. Methods: We measured uBPV in 10 patients: 5 with stroke in the last 14 days (mean=6 days) and 5 healthy controls. Blood pressure was recorded with an ADInstruments NIBP System (Figure 1) for 15 minutes with 200 measurements/second. For each patient, the 15 minutes was divided into 10 epochs of 90 seconds. uBPV was calculated for each epoch and we used a linear mixed-effects model to account for repeated and clustered observations. Results: There was a mean±SD of 172,265±11,354 measurements per patient and 17,226±2,274 measurements per epoch. All measures of systolic uBPV were significantly higher in the stroke patients compared to controls (Table 1). The identical analyses were performed for diastolic and mean arterial blood pressure without significant results. Conclusion: This study demonstrates the feasibility of measuring BPV in stroke patients with finger photo-plethysmography, which was well tolerated and showed the expected increase in systolic BPV after stroke. Our data also introduce the concept of uBPV as a measure of BPV after stroke, which warrants additional study and correlation with clinical and radiographic outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.WP405
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 7
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    Abstract TMP48: Effect of Pre-Morbid Antianxiety and Antidepressant Medications on Ischemic Stroke Functional Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Introduction: Antianxiety and antidepressant medications have shown some neuroprotective effects following stroke. However, the effect of premorbid use of these medications remains unclear. Hypothesis: Pre-morbid exposure to antianxiety or antidepressant medications will negatively impact recovery from acute ischemic stroke, measured by modified Rankin scale (mRS) at 90 days after stroke onset. Methods: This is a secondary analysis of the Albumin in Acute Ischemic Stroke (ALIAS) 2 trial. The primary outcome is 90-day mRS 0-1. The exposure is premorbid antidepressant or antianxiety medication. We fit univariate and multivariate logistic regression models to our outcome, with covariates chosen using a stepwise backwards interactive selection. Results: We included 806 patients with a mean (SD) age of 64.4 (12.8) years. The median (IQR) NIH Stroke Scale was 11 (8, 17) and 54.3% were male, 75.6% were Caucasian, 88.8% received tPA, 72.5% had hypertension, and 20.3% had diabetes. A total of 140/806 (17.4%) of patients took either an antidepressant or antianxiety medication, of which 91 took an antidepressant, 34 took an antianxiety medication, and 15 took both. The median (IQR) mRS Scale was one point higher in patients on antidepressant or antianxiety medication pre-stroke (3 vs. 2, p=0.019). The primary outcome of mRS 0-1 was seen in 37.7% of all patients. Taking an antidepressant or antianxiety medication was associated with lower odds of a good outcome in univariate (OR 0.61, 95% CI 0.41-0.91, p=0.015) and multivariate models (aOR 0.62, 95% CI 0.40-0.95, p=0.027) (Table 1). Conclusion: Pre-morbid exposure to antianxiety or antidepressant medications is associated with a worse outcome after acute ischemic stroke. This may be due to a negative impact of pre-stroke anxiety and depression that outweigh any neuroprotective factors of these medications.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.TMP48
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 8
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    Abstract 47: Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of MESA
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Background: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large prospective epidemiologic study of the clinical factors that can predict transition from asymptomatic to symptomatic cardiovascular disease. Although prior studies have looked at ischemic stroke, they have not systematically examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary stroke risk. Methods: The primary outcome is incident ischemic stroke during follow-up. The predictors are 9 ultrasound-derived measurements and 5 serum measurements related to inflammation. We fit Cox models to ischemic stroke and adjusted for patient age, hypertension, diabetes, total cholesterol, and smoking. Using DeLong’s method, we compared the AUC of the baseline adjusted model to the AUC of the model with predictor variables that were significant in the Cox models, to determine if they improved stroke prediction. Results: We included 6,095 patients with an average age of 61.9 years. The primary outcome of ischemic stroke was seen in 107 patients (1.8%) and the mean follow-up time was 7.7 years. In the Cox models, we found that small artery elasticity (SAE), carotid distensibility (CD), carotid stenosis (CS), and interleukin-6 (IL6) were associated with incident stroke. The AUC of the baseline model to predict stroke, which included patient age, hypertension, diabetes, total cholesterol, and smoking, was 0.745. When we added tertiles of SAE, CD, IL6 and categories of CS, the AUC improved to 0.765 (p=0.021 for difference). Conclusions: In a multiethnic cohort of patients without CVD at baseline, we found several ultrasound measurements and a serum marker of inflammation which predicted the occurrence of a primary ischemic stroke. Adding these basic ultrasound and serum measurements significantly improved the prediction of stroke, which could have implications for primary prevention efforts.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.47
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 9
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    Statin Usage Increases White Matter Hyperintensities : A Post Hoc Analysis of SPRINT-MIND
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  The Neurologist Vol. 28, No. 2 ( 2022-05-23), p. 94-98
    Details
    In: The Neurologist, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 2 ( 2022-05-23), p. 94-98
    Abstract: Progression of white matter hyperintensities (WMHs), a radiographic marker of cerebral small vessel disease, occurs with uncontrolled conventional cerebrovascular risk factors. Less certain, however, is the influence of dyslipidemia and the impact of 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) on WMH progression. The goal of this study was to evaluate the influence of statins on the progression of WMH over a 4-year interval. Methods: We performed a post hoc analysis of the SPRINT-MIND database on those with serial volumetric WMH data. WMH progression was calculated as the difference in WMH volume between the 2 scans and then segmented into tertiles due to rightward skew. We defined statin usage as no therapy (0% of visits), partial therapy (1% to 99% of visits) or full therapy (100% of visits) as logged during study visits. Analysis of variance and χ 2 tests were used for continuous and categorical variables with adjustments made for variables known to influence WMH development. Results: A total of 425 individuals were included in this study: 53% without statins use, 27% partial use, and 20% full use. Demographic characteristics and baseline WMH volumes were similar among the cohort. Those with full statin use were significantly more likely to be in the top tertile of WMH progression (adjusted odds ratio: 2.30, 95% confidence interval: 1.11-4.77, P =0.025), despite improvement in dyslipidemia. Conclusions: SPRINT-MIND participants prescribed a statin were nearly 2.5 times more likely to be within the top tertile of WMH progression over 4 years, despite adjustment for synergistic risk factors and improvement in low-density lipoprotein.
    Type of Medium: Online Resource
    ISSN: 2331-2637
    URL: Article
    DOI: 10.1097/NRL.0000000000000448
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2070987-0
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  • 10
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    Diabetic Retinopathy and Risk of Stroke : A Secondary Analysis of the ACCORD Eye Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 12 ( 2020-12), p. 3733-3736
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 12 ( 2020-12), p. 3733-3736
    Abstract: Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events. Methods: This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%; P =0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20]; P =0.026). This association was not affected by randomization arm in the ACCORD glucose ( P =0.300), lipid ( P =0.660), or blood pressure interventions ( P =0.469). Conclusions: DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030350
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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