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  • Ovid Technologies (Wolters Kluwer Health)  (11)
  • 2010-2014  (11)
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  • Ovid Technologies (Wolters Kluwer Health)  (11)
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Language
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  • 2010-2014  (11)
Year
Subjects(RVK)
  • 1
    Online Resource
    Online Resource
    C-Reactive Protein as a Prognostic Marker After Lacunar Stroke : Levels of Inflammatory Markers in the Treatment of Stroke Study
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 3 ( 2014-03), p. 707-716
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 3 ( 2014-03), p. 707-716
    Abstract: Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods— Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results— Among 1244 patients with lacunar stroke (mean age, 63.3±10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes) and 115 major vascular events (stroke, myocardial infarction, and vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP 〉 4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR, 2.54; 95% CI, 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR, 2.32; 95% CI, 1.15–4.68). hsCRP predicted increased risk of major vascular events (top quartile adjusted HR, 2.04; 95% CI, 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions— Among recent lacunar stroke patients, hsCRP levels predict the risk of recurrent strokes and other vascular events. hsCRP did not predict the response to dual antiplatelets. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00059306.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.004562
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Abstract 67: HsCRP Predicts Recurrent Stroke and Vascular Events among Patients with Lacunar Stroke: The Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Objective: To determine whether high sensitivity C-reactive protein (hsCRP) predicts recurrent stroke and other vascular events among recent lacunar stroke patients. Background: Inflammatory markers have been associated with risk of first stroke. Their role in predicting recurrence is unclear. Methods: The Levels of Inflammatory Markers in the Treatment of Stroke study is an international prospective study of inflammatory markers among recent lacunar stroke patients enrolled in the NIH-funded randomized Secondary Prevention of Small Subcortical Strokes trial. Patients had blood samples drawn, saved at -80 degrees C, and run at a central lab for hsCRP using nephelometry. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (HR, 95% CI) for associations of hsCRP with recurrence risk before and after adjusting for demographics, comorbidities, and statin use. Results: Among 1244 lacunar stroke patients (mean 63.3 ± 10.8 years), median hsCRP was 2.16 mg/L (interquartile range 0.93-4.86), and levels differed by age, sex, smoking, and LDL. Median time between stroke and hsCRP measurement was 60 days, and levels were inversely and weakly correlated with proximity to stroke date (r=-0.06, p=0.039). There were 83 recurrent ischemic strokes (45 lacunes), 16 hemorrhages, and 115 major vascular events (stroke, MI, vascular death). Compared to the bottom quartile, those in the top quartile of hsCRP ( 〉 4.86 mg/dl) were at increased risk of recurrent ischemic stroke (unadjusted HR 2.54, 95% CI 1.30-4.96), and the risk persisted after adjusting for age, sex, race, region, hypertension, smoking, prior history of stroke, diabetes, lipid levels, and statin use (adjusted HR 2.28, 95% CI 1.14-4.57). HsCRP was associated with an increased risk of major vascular events (top quartile adjusted HR 1.98, 95% CI 1.11-3.54). Results were similar using clinical thresholds of high risk hsCRP ( 〉 3 mg/dl). There was no interaction of randomized antiplatelet treatment with hsCRP levels for stroke risk. Conclusions: Among recent lacunar stroke patients, elevated hsCRP levels predict increased risk of recurrent strokes and other vascular events. Levels of inflammatory markers did not predict a response to dual antiplatelet treatment.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.67
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    A quantitative systematic review of domain-specific cognitive impairment in lacunar stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Neurology Vol. 80, No. 3 ( 2013-01-15), p. 315-322
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 80, No. 3 ( 2013-01-15), p. 315-322
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0b013e31827deb85
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract WP394: Insights Into The Cost-effectiveness Of Blood Pressure Management For Secondary Stroke Prevention
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Objective: To determine the relationship between the risk of dementia, risk of recurrent stroke and other factors on the cost-effectiveness of intensive blood pressure management for secondary stroke prevention. Methods: A Markov model incorporated data from the PROGRESS trial. It included cost (2011$) and utility estimates from the literature. Intensive management was a 9mmHg reduction in systolic blood pressure compared to usual management. The cost of the additional medications was assumed to be the cost of perindopril. Relative risk terms modified the probability of adverse events with intensive treatment. Outcomes were recurrent stroke, dementia, recurrent stroke with dementia and death. Quality of life with intensive management was lower than usual treatment. Assumptions were tested with one-way and multi-way sensitivity analyses. Results: For the base case analysis, the lifetime costs of usual management were $80,200 with 5.626 quality adjusted life years (QALYs). The lifetime costs of intensive management were $85,500 with 5.627 QALYs. The incremental cost-effectiveness ratio (ICER) was $5 million, thus the added costs of intensive management were not offset by increased quality of life. However, this conclusion was sensitive to several assumptions. Intensive management became cost-effective (ICER 〈 $100,000) when (1) ages 〈 52 years were treated (base case: 64 years), (2) the quality of life with intensive management increased slightly, by 0.01, (3) the cost of BP medications was $270/year, (4) the probability of recurrent stroke was ≥ 5.4% (base case: 3.7%), or (5) the relative risk of recurrent stroke with intensive management was ≤ 0.69 (base case: 0.77). The probability of dementia or the relative risk of dementia did not influence the model. If the cost of medications to lower BP by 9 mmHg was ≤ $260/year, intensive management was dominant with lower lifetime costs and greater QALYs. Conclusion: With the base case assumptions, intensive BP management was not the cost-effective choice. Nevertheless cost-effective management can be achieved depending on the age of the cohort and the cost of maintenance medications. This analysis highlights important factors to be considered during the planned cost-effectiveness analysis of the SPS3 trial.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP394
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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    Online Resource
  • 5
    Online Resource
    Online Resource
    Stroke Genetics Network (SiGN) Study : Design and Rationale for a Genome-Wide Association Study of Ischemic Stroke Subtypes
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 10 ( 2013-10), p. 2694-2702
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 10 ( 2013-10), p. 2694-2702
    Abstract: Meta-analyses of extant genome-wide data illustrate the need to focus on subtypes of ischemic stroke for gene discovery. The National Institute of Neurological Disorders and Stroke SiGN (Stroke Genetics Network) contributes substantially to meta-analyses that focus on specific subtypes of stroke. Methods— The National Institute of Neurological Disorders and Stroke SiGN includes ischemic stroke cases from 24 genetic research centers: 13 from the United States and 11 from Europe. Investigators harmonize ischemic stroke phenotyping using the Web-based causative classification of stroke system, with data entered by trained and certified adjudicators at participating genetic research centers. Through the Center for Inherited Diseases Research, the Network plans to genotype 10 296 carefully phenotyped stroke cases using genome-wide single nucleotide polymorphism arrays and adds to these another 4253 previously genotyped cases, for a total of 14 549 cases. To maximize power for subtype analyses, the study allocates genotyping resources almost exclusively to cases. Publicly available studies provide most of the control genotypes. Center for Inherited Diseases Research–generated genotypes and corresponding phenotypes will be shared with the scientific community through the US National Center for Biotechnology Information database of Genotypes and Phenotypes, and brain MRI studies will be centrally archived. Conclusions— The Stroke Genetics Network, with its emphasis on careful and standardized phenotyping of ischemic stroke and stroke subtypes, provides an unprecedented opportunity to uncover genetic determinants of ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001857
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 6
    Online Resource
    Online Resource
    Clinical Correlates of Infarct Shape and Volume in Lacunar Strokes : The Secondary Prevention of Small Subcortical Strokes Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 10 ( 2014-10), p. 2952-2958
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 10 ( 2014-10), p. 2952-2958
    Abstract: Infarct size and location are thought to correlate with different mechanisms of lacunar infarcts. We examined the relationship between the size and shape of lacunar infarcts and vascular risk factors and outcomes. Methods— We studied 1679 participants in the Secondary Prevention of Small Subcortical Stroke trial with a lacunar infarct visualized on diffusion-weighted imaging. Infarct volume was measured planimetrically, and shape was classified based on visual analysis after 3-dimensional reconstruction of axial MRI slices. Results— Infarct shape was ovoid/spheroid in 63%, slab in 12%, stick in 7%, and multicomponent in 17%. Median infarct volume was smallest in ovoid/spheroid relative to other shapes: 0.46, 0.65, 0.54, and 0.90 mL, respectively ( P 〈 0.001). Distributions of vascular risk factors were similar across the 4 groups except that patients in the ovoid/spheroid and stick groups were more often diabetic and those with multicomponent had significantly higher blood pressure at study entry. Intracranial stenosis did not differ among groups ( P =0.2). Infarct volume was not associated with vascular risk factors. Increased volume was associated with worse functional status at baseline and 3 months. Overall, 162 recurrent strokes occurred during an average of 3.4 years of follow-up with no difference in recurrent ischemic stroke rate by shape or volume. Conclusions— In patients with recent lacunar stroke, vascular risk factor profile was similar among the different infarct shapes and sizes. Infarct size correlated with worse short-term functional outcome. Neither shape nor volume was predictive of stroke recurrence. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00059306.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005211
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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  • 7
    Online Resource
    Online Resource
    ASA failure: Does the combination ASA/clopidogrel confer better long-term vascular protection?
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Neurology Vol. 82, No. 5 ( 2014-02-04), p. 382-389
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 82, No. 5 ( 2014-02-04), p. 382-389
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000000076
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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    Online Resource
  • 8
    Online Resource
    Online Resource
    X Chromosome Inactivation Skewing in Female Kidney Transplant Donors and Recipients: An Epigenetic Risk Factor for Transplant Outcome : 1964
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Transplantation Journal Vol. 94, No. 10S ( 2012-11), p. 142-
    Details
    In: Transplantation Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 10S ( 2012-11), p. 142-
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/00007890-201211271-00263
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 2035395-9
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  • 9
    Online Resource
    Online Resource
    Predictors of Mortality in Patients With Lacunar Stroke in the Secondary Prevention of Small Subcortical Strokes Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 10 ( 2014-10), p. 2989-2994
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 10 ( 2014-10), p. 2989-2994
    Abstract: The Secondary Prevention of Small Subcortical Stroke trial (SPS3) recruited participants meeting clinical and radiological criteria for symptomatic lacunes. Individuals randomized to dual antiplatelet therapy with clopidogrel and aspirin had an unanticipated increase in all-cause mortality compared with those assigned to aspirin. We investigated the factors associated with mortality in this well-characterized population. Methods— We identified independent predictors of mortality among baseline demographic and clinical factors by Cox regression analysis in participants of the SPS3 trial. Separately, we examined the effect on mortality of nonfatal bleeding during the trial. Results— During a mean follow-up of 3.6 years, the mortality rate was 1.78% per year for the 3020 participants (mean age, 63 years). Significant independent predictors of mortality at study entry were age, diabetes mellitus, history of hypertension, systolic blood pressure (hazard ratio [HR], 1.3 per 20 mm Hg increase), serum hemoglobin 〈 13 g/dL (HR, 1.6), renal function (HR, 1.3 per estimated glomerular filtration rate decrease of 20 mL/min), and body mass index (HR, 1.8 per 10 kg/m 2 decrease). Participants with ischemic heart disease ( P =0.01 for interaction) and normotensive/prehypertensive participants ( P =0.03 for interaction) were at increased risk if assigned to dual antiplatelet therapy. Nonfatal major hemorrhage increased mortality in both treatment arms (HR, 4.5; 95% confidence interval, 3.1–6.6; P 〈 0.001). Conclusions— Unexpected interactions between assigned antiplatelet therapy and each of ischemic heart disease and normal/prehypertensive status accounted for increased mortality among patients with recent lacunar stroke given dual antiplatelet therapy. Despite extensive exploratory analyses, the mechanisms underlying these interactions are uncertain. Clinical Trial Registration— URL: http://www.SPS3ClinicalTrials.gov . Unique identifier: NCT00059306.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005789
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 10
    Online Resource
    Online Resource
    Teaching NeuroImages: Carotid body tumor as a novel cause of cerebral ischemic stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Neurology Vol. 79, No. 6 ( 2012-08-07), p. e58-e58
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 79, No. 6 ( 2012-08-07), p. e58-e58
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0b013e3182635685
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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