Abstract Background Chronic kidney disease (CKD) is associated with higher stroke incidence, but little is known about the impact of CKD on mortality during stroke hospitalization, especially by CKD ...stage and index stroke type. This study assessed the effect of prevalent CKD on risk of dying in the hospital after a stroke. Methods Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients identified by the International Classification of Diseases, Ninth Revision procedure codes (n = 1,127,842) admitted to hospitals between October 2005 and December 2006 with a discharge diagnosis of stroke were included. Independent associations of CKD with in-hospital mortality following stroke were evaluated using multivariable logistic regression. Results Of the sample, 64,985 (6%) had CKD, of which 5,785 (9%) died in the hospital. In multivariable analyses, CKD was associated with mortality overall (OR 1.63, 95% CI = 1.52–1.75) and regardless of stroke type: ischemic stroke (OR 1.70, 95% CI = 1.55–1.86), subarachnoid hemorrhage (OR 1.93, 95% CI = 1.45–2.58), intracerebral hemorrhage (OR 1.28, 95% CI = 1.10–1.49). Association between CKD and greater mortality was more pronounced in younger age groups (CKD*age interaction: p < 0.0001) and in women vs. men (CKD*sex interaction: p < 0.0001). Higher CKD stage was associated with greater mortality odds, but only with Stages 5 (OR 3.21, 95% CI: 2.09–4.92) and 6 (OR 2.92, 95% CI: 2.62–3.25) was this association of significance. Conclusions Presence of CKD is independently associated with higher odds of dying during stroke hospitalization regardless of index stroke type. This adverse association is driven by severe CKD and is more pronounced in relatively younger persons and women.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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Prevention of stroke: a global perspective Pandian, Jeyaraj D; Gall, Seana L; Kate, Mahesh P ...
The Lancet (British edition),
10/2018, Volume:
392, Issue:
10154
Journal Article
Peer reviewed
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke ...prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
There has been a significant increase in obesity rates worldwide with the corresponding surge in diabetes. Diabetes causes various microvascular and macrovascular changes often culminating in major ...clinical complications, 1 of which, is stroke. Although gains have been made over the last 2 decades in reducing the burden of stroke, the recent rise in rates of diabetes threatens to reverse these advances. Of the several mechanistic stroke subtypes, individuals with diabetes are especially susceptible to the consequences of cerebral small vessel diseases. Hyperglycemia confers greater risk of stroke occurrence. This increased risk is often seen in individuals with diabetes and is associated with poorer clinical outcomes (including higher mortality), especially following ischemic stroke. Improving stroke outcomes in individuals with diabetes requires prompt and persistent implementation of evidence-based medical therapies as well as adoption of beneficial lifestyle practices.
Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent ...vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.
Little is known about the contribution of obesity to the higher mortality risk among stroke survivors. We assessed the independent association between body mass index (BMI) and mortality among stroke ...survivors.
Cross-sectional and prospective data from a nationally representative survey of noninstitutionalized civilian U.S. population aged 25 or older (n=20 050) with a baseline history of stroke (n=644) followed up from survey participation (1988-1994) through mortality assessment in 2000. Relationships between BMI and mortality attributable to all causes or cardiovascular causes were examined after adjusting for established prognosticators after stroke.
Stroke survivors were more likely to be overweight (BMI 25 to 29 kg/m2) or obese (BMI > or =30 kg/m2 than those without stroke (64.3% versus 53.2%, P=0.003). In multivariable analysis, overall risk for all-cause mortality increased per kg/m2 of higher BMI (P=0.030), but an interaction between age and BMI (P=0.009) revealed that the association of higher BMI with mortality risk was strongest in younger individuals and declined linearly with increasing age, such that in the elderly, overweightness and obesity had a protective effect. The results were similar for the cardiovascular mortality outcome.
Higher BMI after stroke is associated with a greater risk of all-cause and cardiovascular death among younger individuals. Younger stroke survivors may especially benefit from more vigorous efforts to monitor and treat obesity.
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