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  • 1
    Online Resource
    Online Resource
    Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study
    S. Karger AG ; 2021
    In:  Neuroepidemiology Vol. 55, No. 3 ( 2021), p. 206-215
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 55, No. 3 ( 2021), p. 206-215
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association. 〈 b 〉 〈 i 〉 Aims: 〈 /i 〉 〈 /b 〉 We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 INTERSTROKE is a case-control study and the largest international study of risk factors for first acute stroke, completed in 27 countries. We included individuals with available serum creatinine values and calculated estimated glomerular filtration rate (eGFR). Renal impairment was defined as eGFR & #x3c;60 mL/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 . Multivariable conditional logistic regression was used to determine the association of renal function with stroke. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 21,127 participants, 41.0% were female, the mean age was 62.3 ± 13.4 years, and the mean eGFR was 79.9 ± 23.5 mL/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 . The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001) and differed by region ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). After adjustment, lower eGFR was associated with increased odds of stroke. Renal impairment was associated with increased odds of all stroke (OR 1.35; 95% CI: 1.24–1.47), with higher odds for intracerebral hemorrhage (OR 1.60; 95% CI: 1.35–1.89) than ischemic stroke (OR 1.29; 95% CI: 1.17–1.42) ( 〈 i 〉 p 〈 /i 〉 〈 sub 〉 interaction 〈 /sub 〉 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America ( 〈 i 〉 p 〈 /i 〉 〈 sub 〉 interaction 〈 /sub 〉 & #x3c; 0.001 for all stroke). Renal impairment was also associated with poorer clinical outcome (RRR 2.97; 95% CI: 2.50–3.54 for death within 1 month). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000515239
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1483032-2
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  • 2
    Online Resource
    Online Resource
    Risk Factors for Stroke in the Young (18–45 Years): A Case-Control Analysis of INTERSTROKE Data from 32 Countries
    S. Karger AG ; 2023
    In:  Neuroepidemiology
    Details
    In: Neuroepidemiology, S. Karger AG
    Abstract: Background: It is not clear whether conventional vascular risk factors are responsible for most strokes in patients younger than 45 years of age. Our objective was to evaluate the association of common risk factors with stroke in individuals under 45 years. Methods: INTERSTROKE was a case-control study carried out in 32 countries between 2007 and 2015. Patients presenting within 5 days of symptom onset of a first stroke were enrolled as cases. Controls were age and sex matched to cases and had no history of stroke. Cases and controls underwent similar evaluations. Odds ratios (ORs) and population attributable risks (PARs) were calculated to determine the association of various risk factors with all stroke, ischemic stroke, and intracranial hemorrhage, for patients 45 years of age or younger. Findings: 1,582 case-control pairs were included in this analysis. The mean age of this cohort was 38.5 years (SD 6.32). Overall, 71% strokes were ischemic. Cardiac causes {OR: 8.42 (95% confidence interval [CI]: 3.01–23.5)}; binge drinking of alcohol (OR: 5.44 [95% CI: 1.81–16.4] ); hypertension (OR: 5.41 [95% CI: 3.40–8.58]); ApoB/ApoA1 ratio (OR: 2.74 [95% CI: 1.69–4.46] ); psychosocial stress (OR: 2.33 [95% CI: 1.01–5.41]); smoking (OR: 1.85 [95% CI: 1.17–2.94] ); and increased waist-to-hip ratio (OR: 1.69 [95% CI: 1.04–2.75]) were the most important risk factors for ischemic stroke in these young cases. For intracerebral hemorrhage, only hypertension (OR: 9.08 [95% CI: 5.4 6–15.1]) and binge drinking (OR: 4.06 [95% CI: 1.27–13.0] ) were significant risk factors. The strength of association and population attributable risk (PAR) for hypertension increased with age (PAR 23.3% in those & lt;35 years of age, 50.7% in 35–45 years of age). Interpretation: Conventional risk factors such as hypertension, smoking, binge drinking of alcohol, central obesity, cardiac causes, dyslipidemia, and psychosocial stress are important risk factors for stroke in those younger than 45 years of age. Hypertension is the most significant risk factor in all age groups and across all regions and both stroke subtypes. These risk factors should be identified and modified in early adulthood to prevent strokes in young individuals.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000530675
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1483032-2
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  • 3
    Online Resource
    Online Resource
    Association between Metabolic Syndrome and Cancer
    S. Karger AG ; 2016
    In:  Annals of Nutrition and Metabolism Vol. 68, No. 3 ( 2016), p. 173-179
    Details
    In: Annals of Nutrition and Metabolism, S. Karger AG, Vol. 68, No. 3 ( 2016), p. 173-179
    Abstract: Growing data show the association of metabolic syndrome (MetS) or its components with cancer development and cancer-related mortality. It is suggested that in MetS and cancer association, insulin resistance and insulin-like growth factor 1 system play a key role, especially adipokines secreted from visceral adipocytes, free fatty acids and aromatase activity contribute to this process. It is also reported that MetS has a link with colorectal, breast, endometrial, pancreas, primary liver and, although controversial, prostate cancer. Although every component of MetS is known to have an association with cancer development, it is still debated whether the effects of these components are additive or synergistic. On the other hand, in the association between MetS and cancer, the role of antidiabetic and antihypertensive treatments including thiazolidinedione, insulin, angiotensin receptor blockers is also suggested. The primary approach in MetS-cancer relation is to prevent risk factors. Life style changes including weight loss and a healthy diet are known to decrease cancer risk in normal population. It is postulated that an insulin-sensitizing agent, metformin, has cancer-preventing effects on diabetic patients. This review discusses the relationship between MetS and cancer from different aspects and examines this relationship in some of the cancers suggested to be linked with MetS.
    Type of Medium: Online Resource
    ISSN: 0250-6807 , 1421-9697
    URL: Article
    DOI: 10.1159/000443743
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 1481977-6
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  • 4
    Online Resource
    Online Resource
    Switching Biologics in the Treatment of Psoriasis: A Multicenter Experience
    S. Karger AG ; 2021
    In:  Dermatology Vol. 237, No. 1 ( 2021), p. 22-30
    Details
    In: Dermatology, S. Karger AG, Vol. 237, No. 1 ( 2021), p. 22-30
    Abstract: 〈 b 〉 〈 i 〉 Background/Objective: 〈 /i 〉 〈 /b 〉 The purpose of our study was to provide evidence on the treatment choices, reasons, and results of switching between biologic agents in treating patients with psoriasis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We conducted a retrospective database search of six tertiary referral centers for pso­riasis patients between January 2007 and May 2019. We analyzed patient and treatment characteristics of all patients in the registry. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We enrolled 427 psoriatic patients treated with biologics, and 145 (34%) required a switch to another biologic. The reasons for discontinuing the first biologic agent were inefficacy ( 〈 i 〉 n 〈 /i 〉 = 106, 62.4%), adverse events ( 〈 i 〉 n 〈 /i 〉 = 28, 16.5%), and others ( 〈 i 〉 n 〈 /i 〉 = 36, 21.2%). At week 12, there was a 67.7% reduction in the Psoriasis Area and Severity Index (PASI) score of patients treated with their first biologic, and 51.4% reduction for the second. A drug survival analysis showed no statistically significant difference between the drug survival of first-line biologic agents, but ustekinumab had the highest survival rate among second-line biologics (log-rank 〈 i 〉 p 〈 /i 〉 = 0.010). Multivariate analyses for overall drug discontinuation showed that the occurrence of psoriatic arthritis (OR: 1.883, 95% CI: 1.274–2.782, 〈 i 〉 p 〈 /i 〉 = 0.001), nail involvement (OR: 2.334, 95% CI: 1.534–3.552, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and use of concomitant treatment (OR: 2.303, 95% CI: 1.403 –3.780, 〈 i 〉 p 〈 /i 〉 = 0.001) are predictors for discontinuation. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Discontinuation of treatment was most commonly due to inefficacy. Patients who switched to a different biologic agent showed a similar improvement in PASI scores compared to biologic-naive patients. Switching to a second biologic therapy due to inefficacy or adverse events caused by the first one may improve psoriasis.
    Type of Medium: Online Resource
    ISSN: 1018-8665 , 1421-9832
    URL: Article
    DOI: 10.1159/000504839
    RVK:
    XA 37700
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1482189-8
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