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1. Projections of Endovascular Therapy-Eligible Patients With Stroke for the US Population.

Author

Mistry, Eva A., Khoury, Jane C., Kleindorfer, Dawn O., Kissela, Brett M., Alwell, Kathleen S., Jasne, Adam S., Ferioli, Simona, De Los Rios La Rosa, Felipe, Coleman, Elisheva, Demel, Stacie L., Walsh, Kyle B., Slavin, Sabreena J., Star, Michael, Haverbusch, Mary, Mackey, Jason, Woo, Daniel, Aziz, Yasmin N., Heldner, Mirjam R., Fischer, Urs, and Jadhav, Ashutosh P.

Published
2024
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5. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial

Author

Boyne, Pierce, Billinger, Sandra A., Reisman, Darcy S., Awosika, Oluwole O., Buckley, Sofia, Burson, Jamiah, Carl, Daniel, DeLange, Matthew, Doren, Sarah, Earnest, Melinda, Gerson, Myron, Henry, Madison, Horning, Alli, Khoury, Jane C., Kissela, Brett M., Laughlin, Abigail, McCartney, Kiersten, McQuaid, Thomas, Miller, Allison, Moores, Alexandra, Palmer, Jacqueline A., Sucharew, Heidi, Thompson, Elizabeth D., Wagner, Erin, Ward, Jaimie, Wasik, Emily Patton, Whitaker, Alicen A., Wright, Henry, and Dunning, Kari

Abstract

IMPORTANCE: For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. OBJECTIVE: To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. INTERVENTIONS: Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. MAIN OUTCOMES AND MEASURES: The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. RESULTS: Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, −9 to 33 m]; mean difference, 15 m [95% CI, −13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. CONCLUSIONS AND RELEVANCE: These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03760016

Published
2023
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6. Substance Use and Performance of Toxicology Screens in the Greater Cincinnati Northern Kentucky Stroke Study

Author

Madsen, Tracy E., Cummings, Olivia W., De Los Rios La Rosa, Felipe, Khoury, Jane C., Alwell, Kathleen, Woo, Daniel, Ferioli, Simona, Martini, Sharyl, Adeoye, Opeolu, Khatri, Pooja, Flaherty, Matthew L., Mackey, Jason, Mistry, Eva A., Demel, Stacie L., Coleman, Elisheva, Jasne, Adam S., Slavin, Sabreena J., Walsh, Kyle, Star, Michael, Broderick, Joseph P., Kissela, Brett M., and Kleindorfer, Dawn O.

Published
2022
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7. Multi‐phenotype analyses of hemostatic traits with cardiovascular events reveal novel genetic associations

Author

Temprano‐Sagrera, Gerard, Sitlani, Colleen M., Bone, William P., Martin‐Bornez, Miguel, Voight, Benjamin F., Morrison, Alanna C., Damrauer, Scott M., de Vries, Paul S., Smith, Nicholas L., Sabater‐Lleal, Maria, Dehghan, Abbas, Heath, Adam S, Morrison, Alanna C, Reiner, Alex P, Johnson, Andrew, Richmond, Anne, Peters, Annette, van Hylckama Vlieg, Astrid, McKnight, Barbara, Psaty, Bruce M, Hayward, Caroline, Ward‐Caviness, Cavin, O’Donnell, Christopher, Chasman, Daniel, Strachan, David P, Tregouet, David A, Mook‐Kanamori, Dennis, Gill, Dipender, Thibord, Florian, Asselbergs, Folkert W, Leebeek, Frank W.G., Rosendaal, Frits R, Davies, Gail, Homuth, Georg, Temprano, Gerard, Campbell, Harry, Taylor, Herman A, Bressler, Jan, Huffman, Jennifer E, Rotter, Jerome I, Yao, Jie, Wilson, James F, Bis, Joshua C, Hahn, Julie M, Desch, Karl C, Wiggins, Kerri L, Raffield, Laura M, Bielak, Lawrence F, Yanek, Lisa R, Kleber, Marcus E, Sabater‐Lleal, Maria, Mueller, Martina, Kavousi, Maryam, Mangino, Massimo, Liu, Melissa, Brown, Michael R, Conomos, Matthew P, Jhun, Min‐A, Chen, Ming‐Huei, de Maat, Moniek P.M., Pankratz, Nathan, Smith, Nicholas L, Peyser, Patricia A, Elliot, Paul, de Vries, Paul S, Wei, Peng, Wild, Philipp S, Morange, Pierre E, van der Harst, Pim, Yang, Qiong, Le, Ngoc‐Quynh, Marioni, Riccardo, Li, Ruifang, Damrauer, Scott M, Cox, Simon R, Trompet, Stella, Felix, Stephan B, Völker, Uwe, Tang, Weihong, Koenig, Wolfgang, Jukema, J. Wouter, Guo, Xiuqing, Lindstrom, Sara, Wang, Lu, Smith, Erin N, Gordon, William, van Hylckama Vlieg, Astrid, de Andrade, Mariza, Brody, Jennifer A, Pattee, Jack W, Haessler, Jeffrey, Brumpton, Ben M, Chasman, Daniel I, Suchon, Pierre, Chen, Ming‐Huei, Turman, Constance, Germain, Marine, Wiggins, Kerri L, MacDonald, James, Braekkan, Sigrid K, Armasu, Sebastian M, Pankratz, Nathan, Jackson, Rabecca D, Nielsen, Jonas B, Giulianini, Franco, Puurunen, Marja K, Ibrahim, Manal, Heckbert, Susan R, Bammler, Theo K, Frazer, Kelly A, McCauley, Bryan M, Taylor, Kent, Pankow, James S, Reiner, Alexander P, Gabrielsen, Maiken E, Deleuze, Jean‐François, O’Donnell, Chris J, Kim, Jihye, McKnight, Barbara, Kraft, Peter, Hansen, John‐Bjarne, Rosendaal, Frits R, Heit, John A, Psaty, Bruce M, Tang, Weihong, Kooperberg, Charles, Hveem, Kristian, Ridker, Paul M, Morange, Pierre‐Emmanuel, Johnson, Andrew D, Kabrhel, Christopher, Trégouët, David‐Alexandre, Smith, Nicholas L, Malik, Rainer, Chauhan, Ganesh, Traylor, Matthew, Sargurupremraj, Muralidharan, Okada, Yukinori, Mishra, Aniket, Rutten‐Jacobs, Loes, Giese, Anne‐Katrin, van der Laan, Sander W, Gretarsdottir, Solveig, Anderson, Christopher D, Chong, Michael, Adams, Hieab HH, Ago, Tetsuro, Almgren, Peter, Amouyel, Philippe, Ay, Hakan, Bartz, Traci M, Benavente, Oscar R, Bevan, Steve, Boncoraglio, Giorgio B, Brown, Robert D, Butterworth, Adam S, Carrera, Caty, Carty, Cara L, Chasman, Daniel I, Chen, Wei‐Min, Cole, John W, Correa, Adolfo, Cotlarciuc, Ioana, Cruchaga, Carlos, Danesh, John, de Bakker, Paul IW, DeStefano, Anita L, den Hoed, Marcel, Duan, Qing, Engelter, Stefan T, Falcone, Guido J, Gottesman, Rebecca F, Grewal, Raji P, Gudnason, Vilmundur, Gustafsson, Stefan, Haessler, Jeffrey, Harris, Tamara B, Hassan, Ahamad, Havulinna, Aki S, Heckbert, Susan R, Holliday, Elizabeth G, Howard, George, Hsu, Fang‐Chi, Hyacinth, Hyacinth I, Arfan Ikram, M, Ingelsson, Erik, Irvin, Marguerite R, Jian, Xueqiu, Jiménez‐Conde, Jordi, Johnson, Julie A, Jukema, J Wouter, Kanai, Masahiro, Keene, Keith L, Kissela, Brett M, Kleindorfer, Dawn O, Kooperberg, Charles, Kubo, Michiaki, Lange, Leslie A, Langefeld, Carl D, Langenberg, Claudia, Launer, Lenore J, Lee, Jin‐Moo, Lemmens, Robin, Leys, Didier, Lewis, Cathryn M, Lin, Wei‐Yu, Lindgren, Arne G, Lorentzen, Erik, Magnusson, Patrik K, Maguire, Jane, Manichaikul, Ani, McArdle, Patrick F, Meschia, James F, Mitchell, Braxton D, Mosley, Thomas H, Nalls, Michael A, Ninomiya, Toshiharu, O’Donnell, Martin J, Psaty, Bruce M, Pulit, Sara L, Rannikmäe, Kristiina, Reiner, Alexander P, Rexrode, Kathryn M, Rice, Kenneth, Rich, Stephen S, Ridker, Paul M, Rost, Natalia S, Rothwell, Peter M, Rotter, Jerome I, Rundek, Tatjana, Sacco, Ralph L, Sakaue, Saori, Sale, Michele M, Salomaa, Veikko, Sapkota, Bishwa R, Schmidt, Reinhold, Schmidt, Carsten O, Schminke, Ulf, Sharma, Pankaj, Slowik, Agnieszka, Sudlow, Cathie LM, Tanislav, Christian, Tatlisumak, Turgut, Taylor, Kent D, Thijs, Vincent NS, Thorleifsson, Gudmar, Thorsteinsdottir, Unnur, Tiedt, Steffen, Trompet, Stella, Tzourio, Christophe, van Duijn, Cornelia M, Walters, Matthew, Wareham, Nicholas J, Wassertheil‐Smoller, Sylvia, Wilson, James G, Wiggins, Kerri L, Yang, Qiong, Yusuf, Salim, Amin, Najaf, Aparicio, Hugo S, Arnett, Donna K, Attia, John, Beiser, Alexa S, Berr, Claudine, Buring, Julie E, Bustamante, Mariana, Caso, Valeria, Cheng, Yu‐Ching, Hoan Choi, Seung, Chowhan, Ayesha, Cullell, Natalia, Dartigues, Jean‐François, Delavaran, Hossein, Delgado, Pilar, Dörr, Marcus, Engström, Gunnar, Ford, Ian, Gurpreet, Wander S, Hamsten, Anders, Heitsch, Laura, Hozawa, Atsushi, Ibanez, Laura, Ilinca, Andreea, Ingelsson, Martin, Iwasaki, Motoki, Jackson, Rebecca D, Jood, Katarina, Jousilahti, Pekka, Kaffashian, Sara, Kalra, Lalit, Kamouchi, Masahiro, Kitazono, Takanari, Kjartansson, Olafur, Kloss, Manja, Koudstaal, Peter J, Krupinski, Jerzy, Labovitz, Daniel L, Laurie, Cathy C, Levi, Christopher R, Li, Linxin, Lind, Lars, Lindgren, Cecilia M, Lioutas, Vasileios, Mei Liu, Yong, Lopez, Oscar L, Makoto, Hirata, Martinez‐Majander, Nicolas, Matsuda, Koichi, Minegishi, Naoko, Montaner, Joan, Morris, Andrew P, Muiño, Elena, Müller‐Nurasyid, Martina, Norrving, Bo, Ogishima, Soichi, Parati, Eugenio A, Reddy Peddareddygari, Leema, Pedersen, Nancy L, Pera, Joanna, Perola, Markus, Pezzini, Alessandro, Pileggi, Silvana, Rabionet, Raquel, Riba‐Llena, Iolanda, Ribasés, Marta, Romero, Jose R, Roquer, Jaume, Rudd, Anthony G, Sarin, Antti‐Pekka, Sarju, Ralhan, Sarnowski, Chloe, Sasaki, Makoto, Satizabal, Claudia L, Satoh, Mamoru, Sattar, Naveed, Sawada, Norie, Sibolt, Gerli, Sigurdsson, Ásgeir, Smith, Albert, Sobue, Kenji, Soriano‐Tárraga, Carolina, Stanne, Tara, Colin Stine, O, Stott, David J, Strauch, Konstantin, Takai, Takako, Tanaka, Hideo, Tanno, Kozo, Teumer, Alexander, Tomppo, Liisa, Torres‐Aguila, Nuria P, Touze, Emmanuel, Tsugane, Shoichiro, Uitterlinden, Andre G, Valdimarsson, Einar M, van der Lee, Sven J, Völzke, Henry, Wakai, Kenji, Weir, David, Williams, Stephen R, Wolfe, Charles DA, Wong, Quenna, Xu, Huichun, Yamaji, Taiki, Sanghera, Dharambir K, Melander, Olle, Jern, Christina, Strbian, Daniel, Fernandez‐Cadenas, Israel, Longstreth, W T, Rolfs, Arndt, Hata, Jun, Woo, Daniel, Rosand, Jonathan, Pare, Guillaume, Hopewell, Jemma C, Saleheen, Danish, Stefansson, Kari, Worrall, Bradford B, Kittner, Steven J, Seshadri, Sudha, Fornage, Myriam, Markus, Hugh S, Howson, Joanna MM, Kamatani, Yoichiro, Debette, Stephanie, and Dichgans, Martin

Abstract

Multi‐phenotype analysis of genetically correlated phenotypes can increase the statistical power to detect loci associated with multiple traits, leading to the discovery of novel loci. This is the first study to date to comprehensively analyze the shared genetic effects within different hemostatic traits, and between these and their associated disease outcomes.

Published
2022
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8. Multi‐phenotype analyses of hemostatic traits with cardiovascular events reveal novel genetic associations

Author

Temprano‐Sagrera, Gerard, Sitlani, Colleen M., Bone, William P., Martin‐Bornez, Miguel, Voight, Benjamin F., Morrison, Alanna C., Damrauer, Scott M., de Vries, Paul S., Smith, Nicholas L., Sabater‐Lleal, Maria, Dehghan, Abbas, Heath, Adam S, Morrison, Alanna C, Reiner, Alex P, Johnson, Andrew, Richmond, Anne, Peters, Annette, van Hylckama Vlieg, Astrid, McKnight, Barbara, Psaty, Bruce M, Hayward, Caroline, Ward‐Caviness, Cavin, O’Donnell, Christopher, Chasman, Daniel, Strachan, David P, Tregouet, David A, Mook‐Kanamori, Dennis, Gill, Dipender, Thibord, Florian, Asselbergs, Folkert W, Leebeek, Frank W.G., Rosendaal, Frits R, Davies, Gail, Homuth, Georg, Temprano, Gerard, Campbell, Harry, Taylor, Herman A, Bressler, Jan, Huffman, Jennifer E, Rotter, Jerome I, Yao, Jie, Wilson, James F, Bis, Joshua C, Hahn, Julie M, Desch, Karl C, Wiggins, Kerri L, Raffield, Laura M, Bielak, Lawrence F, Yanek, Lisa R, Kleber, Marcus E, Sabater‐Lleal, Maria, Mueller, Martina, Kavousi, Maryam, Mangino, Massimo, Liu, Melissa, Brown, Michael R, Conomos, Matthew P, Jhun, Min‐A, Chen, Ming‐Huei, de Maat, Moniek P.M., Pankratz, Nathan, Smith, Nicholas L, Peyser, Patricia A, Elliot, Paul, de Vries, Paul S, Wei, Peng, Wild, Philipp S, Morange, Pierre E, van der Harst, Pim, Yang, Qiong, Le, Ngoc‐Quynh, Marioni, Riccardo, Li, Ruifang, Damrauer, Scott M, Cox, Simon R, Trompet, Stella, Felix, Stephan B, Völker, Uwe, Tang, Weihong, Koenig, Wolfgang, Jukema, J. Wouter, Guo, Xiuqing, Lindstrom, Sara, Wang, Lu, Smith, Erin N, Gordon, William, van Hylckama Vlieg, Astrid, de Andrade, Mariza, Brody, Jennifer A, Pattee, Jack W, Haessler, Jeffrey, Brumpton, Ben M, Chasman, Daniel I, Suchon, Pierre, Chen, Ming‐Huei, Turman, Constance, Germain, Marine, Wiggins, Kerri L, MacDonald, James, Braekkan, Sigrid K, Armasu, Sebastian M, Pankratz, Nathan, Jackson, Rabecca D, Nielsen, Jonas B, Giulianini, Franco, Puurunen, Marja K, Ibrahim, Manal, Heckbert, Susan R, Bammler, Theo K, Frazer, Kelly A, McCauley, Bryan M, Taylor, Kent, Pankow, James S, Reiner, Alexander P, Gabrielsen, Maiken E, Deleuze, Jean‐François, O’Donnell, Chris J, Kim, Jihye, McKnight, Barbara, Kraft, Peter, Hansen, John‐Bjarne, Rosendaal, Frits R, Heit, John A, Psaty, Bruce M, Tang, Weihong, Kooperberg, Charles, Hveem, Kristian, Ridker, Paul M, Morange, Pierre‐Emmanuel, Johnson, Andrew D, Kabrhel, Christopher, Trégouët, David‐Alexandre, Smith, Nicholas L, Malik, Rainer, Chauhan, Ganesh, Traylor, Matthew, Sargurupremraj, Muralidharan, Okada, Yukinori, Mishra, Aniket, Rutten‐Jacobs, Loes, Giese, Anne‐Katrin, van der Laan, Sander W, Gretarsdottir, Solveig, Anderson, Christopher D, Chong, Michael, Adams, Hieab HH, Ago, Tetsuro, Almgren, Peter, Amouyel, Philippe, Ay, Hakan, Bartz, Traci M, Benavente, Oscar R, Bevan, Steve, Boncoraglio, Giorgio B, Brown, Robert D, Butterworth, Adam S, Carrera, Caty, Carty, Cara L, Chasman, Daniel I, Chen, Wei‐Min, Cole, John W, Correa, Adolfo, Cotlarciuc, Ioana, Cruchaga, Carlos, Danesh, John, de Bakker, Paul IW, DeStefano, Anita L, den Hoed, Marcel, Duan, Qing, Engelter, Stefan T, Falcone, Guido J, Gottesman, Rebecca F, Grewal, Raji P, Gudnason, Vilmundur, Gustafsson, Stefan, Haessler, Jeffrey, Harris, Tamara B, Hassan, Ahamad, Havulinna, Aki S, Heckbert, Susan R, Holliday, Elizabeth G, Howard, George, Hsu, Fang‐Chi, Hyacinth, Hyacinth I, Arfan Ikram, M, Ingelsson, Erik, Irvin, Marguerite R, Jian, Xueqiu, Jiménez‐Conde, Jordi, Johnson, Julie A, Jukema, J Wouter, Kanai, Masahiro, Keene, Keith L, Kissela, Brett M, Kleindorfer, Dawn O, Kooperberg, Charles, Kubo, Michiaki, Lange, Leslie A, Langefeld, Carl D, Langenberg, Claudia, Launer, Lenore J, Lee, Jin‐Moo, Lemmens, Robin, Leys, Didier, Lewis, Cathryn M, Lin, Wei‐Yu, Lindgren, Arne G, Lorentzen, Erik, Magnusson, Patrik K, Maguire, Jane, Manichaikul, Ani, McArdle, Patrick F, Meschia, James F, Mitchell, Braxton D, Mosley, Thomas H, Nalls, Michael A, Ninomiya, Toshiharu, O’Donnell, Martin J, Psaty, Bruce M, Pulit, Sara L, Rannikmäe, Kristiina, Reiner, Alexander P, Rexrode, Kathryn M, Rice, Kenneth, Rich, Stephen S, Ridker, Paul M, Rost, Natalia S, Rothwell, Peter M, Rotter, Jerome I, Rundek, Tatjana, Sacco, Ralph L, Sakaue, Saori, Sale, Michele M, Salomaa, Veikko, Sapkota, Bishwa R, Schmidt, Reinhold, Schmidt, Carsten O, Schminke, Ulf, Sharma, Pankaj, Slowik, Agnieszka, Sudlow, Cathie LM, Tanislav, Christian, Tatlisumak, Turgut, Taylor, Kent D, Thijs, Vincent NS, Thorleifsson, Gudmar, Thorsteinsdottir, Unnur, Tiedt, Steffen, Trompet, Stella, Tzourio, Christophe, van Duijn, Cornelia M, Walters, Matthew, Wareham, Nicholas J, Wassertheil‐Smoller, Sylvia, Wilson, James G, Wiggins, Kerri L, Yang, Qiong, Yusuf, Salim, Amin, Najaf, Aparicio, Hugo S, Arnett, Donna K, Attia, John, Beiser, Alexa S, Berr, Claudine, Buring, Julie E, Bustamante, Mariana, Caso, Valeria, Cheng, Yu‐Ching, Hoan Choi, Seung, Chowhan, Ayesha, Cullell, Natalia, Dartigues, Jean‐François, Delavaran, Hossein, Delgado, Pilar, Dörr, Marcus, Engström, Gunnar, Ford, Ian, Gurpreet, Wander S, Hamsten, Anders, Heitsch, Laura, Hozawa, Atsushi, Ibanez, Laura, Ilinca, Andreea, Ingelsson, Martin, Iwasaki, Motoki, Jackson, Rebecca D, Jood, Katarina, Jousilahti, Pekka, Kaffashian, Sara, Kalra, Lalit, Kamouchi, Masahiro, Kitazono, Takanari, Kjartansson, Olafur, Kloss, Manja, Koudstaal, Peter J, Krupinski, Jerzy, Labovitz, Daniel L, Laurie, Cathy C, Levi, Christopher R, Li, Linxin, Lind, Lars, Lindgren, Cecilia M, Lioutas, Vasileios, Mei Liu, Yong, Lopez, Oscar L, Makoto, Hirata, Martinez‐Majander, Nicolas, Matsuda, Koichi, Minegishi, Naoko, Montaner, Joan, Morris, Andrew P, Muiño, Elena, Müller‐Nurasyid, Martina, Norrving, Bo, Ogishima, Soichi, Parati, Eugenio A, Reddy Peddareddygari, Leema, Pedersen, Nancy L, Pera, Joanna, Perola, Markus, Pezzini, Alessandro, Pileggi, Silvana, Rabionet, Raquel, Riba‐Llena, Iolanda, Ribasés, Marta, Romero, Jose R, Roquer, Jaume, Rudd, Anthony G, Sarin, Antti‐Pekka, Sarju, Ralhan, Sarnowski, Chloe, Sasaki, Makoto, Satizabal, Claudia L, Satoh, Mamoru, Sattar, Naveed, Sawada, Norie, Sibolt, Gerli, Sigurdsson, Ásgeir, Smith, Albert, Sobue, Kenji, Soriano‐Tárraga, Carolina, Stanne, Tara, Colin Stine, O, Stott, David J, Strauch, Konstantin, Takai, Takako, Tanaka, Hideo, Tanno, Kozo, Teumer, Alexander, Tomppo, Liisa, Torres‐Aguila, Nuria P, Touze, Emmanuel, Tsugane, Shoichiro, Uitterlinden, Andre G, Valdimarsson, Einar M, van der Lee, Sven J, Völzke, Henry, Wakai, Kenji, Weir, David, Williams, Stephen R, Wolfe, Charles DA, Wong, Quenna, Xu, Huichun, Yamaji, Taiki, Sanghera, Dharambir K, Melander, Olle, Jern, Christina, Strbian, Daniel, Fernandez‐Cadenas, Israel, Longstreth, W T, Rolfs, Arndt, Hata, Jun, Woo, Daniel, Rosand, Jonathan, Pare, Guillaume, Hopewell, Jemma C, Saleheen, Danish, Stefansson, Kari, Worrall, Bradford B, Kittner, Steven J, Seshadri, Sudha, Fornage, Myriam, Markus, Hugh S, Howson, Joanna MM, Kamatani, Yoichiro, Debette, Stephanie, and Dichgans, Martin

Abstract

Multi‐phenotype analysis of genetically correlated phenotypes can increase the statistical power to detect loci associated with multiple traits, leading to the discovery of novel loci. This is the first study to date to comprehensively analyze the shared genetic effects within different hemostatic traits, and between these and their associated disease outcomes. To discover novel genetic associations by combining summary data of correlated hemostatic traits and disease events. Summary statistics from genome wide‐association studies (GWAS) from seven hemostatic traits (factor VII [FVII], factor VIII [FVIII], von Willebrand factor [VWF] factor XI [FXI], fibrinogen, tissue plasminogen activator [tPA], plasminogen activator inhibitor 1 [PAI‐1]) and three major cardiovascular (CV) events (venous thromboembolism [VTE], coronary artery disease [CAD], ischemic stroke [IS]), were combined in 27 multi‐trait combinations using metaUSAT. Genetic correlations between phenotypes were calculated using Linkage Disequilibrium Score Regression (LDSC). Newly associated loci were investigated for colocalization. We considered a significance threshold of 1.85 × 10−9obtained after applying Bonferroni correction for the number of multi‐trait combinations performed (n= 27). Across the 27 multi‐trait analyses, we found 4 novel pleiotropic loci (XXYLT1, KNG1, SUGP1/MAU2, TBL2/MLXIPL) that were not significant in the original individual datasets, were not described in previous GWAS for the individual traits, and that presented a common associated variant between the studied phenotypes. The discovery of four novel loci contributes to the understanding of the relationship between hemostasis and CV events and elucidate common genetic factors between these traits.

Published
2022
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9. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Author

Tsao, Connie W., Aday, Aaron W., Almarzooq, Zaid I., Alonso, Alvaro, Beaton, Andrea Z., Bittencourt, Marcio S., Boehme, Amelia K., Buxton, Alfred E., Carson, April P., Commodore-Mensah, Yvonne, Elkind, Mitchell S.V., Evenson, Kelly R., Eze-Nliam, Chete, Ferguson, Jane F., Generoso, Giuliano, Ho, Jennifer E., Kalani, Rizwan, Khan, Sadiya S., Kissela, Brett M., Knutson, Kristen L., Levine, Deborah A., Lewis, Tené T., Liu, Junxiu, Loop, Matthew Shane, Ma, Jun, Mussolino, Michael E., Navaneethan, Sankar D., Perak, Amanda Marma, Poudel, Remy, Rezk-Hanna, Mary, Roth, Gregory A., Schroeder, Emily B., Shah, Svati H., Thacker, Evan L., VanWagner, Lisa B., Virani, Salim S., Voecks, Jenifer H., Wang, Nae-Yuh, Yaffe, Kristine, and Martin, Seth S.

Published
2022
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10. Racial Differences in Atrial Cardiopathy Phenotypes in Ischemic Stroke Patients.

Author

Kamel, Hooman, Alwell, Kathleen, Kissela, Brett M., Sucharew, Heidi J., Woo, Daniel, Flaherty, Matthew, Ferioli, Simona, Demel, Stacie L., Moomaw, Charles J., Walsh, Kyle, Mackey, Jason, De Los Rios La Rosa, Felipe, Jasne, Adam, Slavin, Sabreena, Martini, Sharyl, Adeoye, Opeolu, Baig, Tehniyat, Chen, Monica L., Levitan, Emily B., and Soliman, Elsayed Z.

Published
2021
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11. C-reactive protein and stroke risk in blacks and whites: The REasons for Geographic And Racial Differences in Stroke cohort.

Author

Evans, Christina R., Long, D. Leann, Howard, George, McClure, Leslie A., Zakai, Neil A., Jenny, Nancy S., Kissela, Brett M., Safford, Monika M., Howard, Virginia J., and Cushman, Mary

Abstract

Background: C-reactive protein (CRP) is an inflammatory biomarker used in vascular risk prediction, though with less data in people of color. Blacks have higher stroke incidence and also higher CRP than whites. We studied the association of CRP with ischemic stroke risk in blacks and whites.Methods: REGARDS, an observational cohort study, recruited and followed 30,239 black and white Americans 45 years and older for ischemic stroke. We calculated hazard ratios and 95% CIs of ischemic stroke by CRP category (<1, 1-3, 3-10, and ≥10 mg/L) adjusted for age, sex and stroke risk factors.Results: There were 292 incident ischemic strokes among blacks and 439 in whites over 6.9 years of follow-up. In whites, the risk was elevated for CRP in the range from 3 to 10 mg/L and even higher for CRP >10 mg/L, whereas in blacks, an association was only seen for CRP >10 mg/L. Considered as a continuous variable, the risk factor-adjusted hazard ratios per SD higher lnCRP were 1.18 (95% CI 1.09-1.28) overall, 1.14 (95% CI 1.00-1.29) in blacks, and 1.22 (95% CI 1.10-1.35) in whites. Spline regression analysis visually confirmed the race difference in the association.Conclusions: CRP may not be equally useful in stroke risk assessment in blacks and whites. Confirmation, similar study for coronary heart disease, and identification of reasons for these racial differences require further study. [ABSTRACT FROM AUTHOR]

Published
2019
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12. Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS

Author

Madsen, Tracy E., Khoury, Jane C., Leppert, Michelle, Alwell, Kathleen, Moomaw, Charles J., Sucharew, Heidi, Woo, Daniel, Ferioli, Simona, Martini, Sharyl, Adeoye, Opeolu, Khatri, Pooja, Flaherty, Matthew, De Los Rios La Rosa, Felipe, Mackey, Jason, Mistry, Eva, Demel, Stacie L., Coleman, Elisheva, Jasne, Adam, Slavin, Sabreena J., Walsh, Kyle, Star, Michael, Broderick, Joseph P., Kissela, Brett M., and Kleindorfer, Dawn O.

Abstract

Supplemental Digital Content is available in the text.

Published
2020
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13. Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association

Author

Virani, Salim S., Alonso, Alvaro, Benjamin, Emelia J., Bittencourt, Marcio S., Callaway, Clifton W., Carson, April P., Chamberlain, Alanna M., Chang, Alexander R., Cheng, Susan, Delling, Francesca N., Djousse, Luc, Elkind, Mitchell S.V., Ferguson, Jane F., Fornage, Myriam, Khan, Sadiya S., Kissela, Brett M., Knutson, Kristen L., Kwan, Tak W., Lackland, Daniel T., Lewis, Tené T., Lichtman, Judith H., Longenecker, Chris T., Loop, Matthew Shane, Lutsey, Pamela L., Martin, Seth S., Matsushita, Kunihiro, Moran, Andrew E., Mussolino, Michael E., Perak, Amanda Marma, Rosamond, Wayne D., Roth, Gregory A., Sampson, Uchechukwu K.A., Satou, Gary M., Schroeder, Emily B., Shah, Svati H., Shay, Christina M., Spartano, Nicole L., Stokes, Andrew, Tirschwell, David L., VanWagner, Lisa B., and Tsao, Connie W.

Published
2020
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14. Temporal Trends of Sex Differences in Transient Ischemic Attack Incidence Within a Population.

Author

Madsen, Tracy E., Khoury, Jane C., Alwell, Kathleen, Moomaw, Charles J., Rademacher, Eric, Flaherty, Matthew L., Woo, Daniel, La Rosa, Felipe De Los Rios, Mackey, Jason, Martini, Sharyl, Ferioli, Simona, Adeoye, Opeolu, Khatri, Pooja, Broderick, Joseph P., Kissela, Brett M., and Kleindorfer, Dawn

Abstract

Objective: Previously we reported that ischemic stroke incidence is declining over time for men but not women. We sought to describe temporal trends of sex differences in incidence of transient ischemic attack (TIA) within the same large, biracial population. Methods: Among the population of 1.3 million in the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) region, TIAs among area residents (≥20 years old) were identified at all local hospitals. Out of hospital cases were ascertained using a sampling scheme. First-ever cases and first within each study period for a patient was included in incidence rates. All cases were physician-adjudicated. Incidence rates (during July 93-June 94 and calendar years 1999, 2005, and 2010) were calculated using the age-, race-, and sex-specific number of TIAs divided by the GCNKSS population in that group; rates were standardized to the 2010 U.S. population. t Tests with Bonferroni correction were used to compare rates over time. Results: There were a total of 4746 TIA events; 53% were female, and 12% were black. In males, incidence decreased from 153 (95% confidence interval [CI] 139-167) per 100,000 in 1993/4 to 117 (95% CI 107-128) in 2010 (P <.05 for trend test) but was similar over time among females (107 (95% CI 97-116) to 102 (95%CI 94-111), P >.05). Conclusions: Within the GCNKSS population, TIA incidence decreased significantly over time in males but not females, data which parallels trends in ischemic stroke in the GCNKSS over the same time period. Future research is needed to determine if these sex differences in incidence over time continue past 2010. [ABSTRACT FROM AUTHOR]

Published
2019
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15. Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers.

Author

McCarthy, Michael J., Bakas, Tamilyn, Schellinger, Jeffrey, Stapleton, Katie, and Kissela, Brett M.

Subjects
CAREGIVERS, PSYCHOLOGY of caregivers, COMMUNICATION, STATISTICAL correlation, LIFE skills, EVALUATION of medical care, MEMORY, SURVIVAL rate, QUESTIONNAIRES, RESEARCH funding, SELF-evaluation, SOCIAL participation, PSYCHOLOGY of Spouses, T-test (Statistics), THOUGHT & thinking, DATA analysis, ACTIVITIES of daily living, BODY movement, BURDEN of care, STROKE patients, DESCRIPTIVE statistics
Abstract

Background: Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers. Objectives: This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms. Methods: Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners' ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up. Results: Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress. Conclusions: Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers. [ABSTRACT FROM AUTHOR]

Published
2018
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17. Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Author

Benjamin, Emelia J., Muntner, Paul, Alonso, Alvaro, Bittencourt, Marcio S., Callaway, Clifton W., Carson, April P., Chamberlain, Alanna M., Chang, Alexander R., Cheng, Susan, Das, Sandeep R., Delling, Francesca N., Djousse, Luc, Elkind, Mitchell S.V., Ferguson, Jane F., Fornage, Myriam, Jordan, Lori Chaffin, Khan, Sadiya S., Kissela, Brett M., Knutson, Kristen L., Kwan, Tak W., Lackland, Daniel T., Lewis, Tené T., Lichtman, Judith H., Longenecker, Chris T., Loop, Matthew Shane, Lutsey, Pamela L., Martin, Seth S., Matsushita, Kunihiro, Moran, Andrew E., Mussolino, Michael E., O’Flaherty, Martin, Pandey, Ambarish, Perak, Amanda M., Rosamond, Wayne D., Roth, Gregory A., Sampson, Uchechukwu K.A., Satou, Gary M., Schroeder, Emily B., Shah, Svati H., Spartano, Nicole L., Stokes, Andrew, Tirschwell, David L., Tsao, Connie W., Turakhia, Mintu P., VanWagner, Lisa B., Wilkins, John T., Wong, Sally S., and Virani, Salim S.

Published
2019
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18. Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors

Author

Howard, Virginia J., Madsen, Tracy E., Kleindorfer, Dawn O., Judd, Suzanne E., Rhodes, J. David, Soliman, Elsayed Z., Kissela, Brett M., Safford, Monika M., Moy, Claudia S., McClure, Leslie A., Howard, George, and Cushman, Mary

Abstract

IMPORTANCE: Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals. OBJECTIVE: To examine incidence and risk factors for ischemic stroke by sex for black and white individuals. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018. EXPOSURES: Sex and race. MAIN OUTCOMES AND MEASURES: Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors. RESULTS: A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors. CONCLUSIONS AND RELEVANCE: For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.

Published
2019
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19. Participation in Get With The Guidelines–Stroke and Its Association With Quality of Care for Stroke

Author

Howard, George, Schwamm, Lee H., Donnelly, John P., Howard, Virginia J., Jasne, Adam, Smith, Eric E., Rhodes, J. David, Kissela, Brett M., Fonarow, Gregg C., Kleindorfer, Dawn O., and Albright, Karen C.

Abstract

IMPORTANCE: Get With The Guidelines–Stroke (GWTG-Stroke) is an American Heart Association/American Stroke Association stroke-care quality-improvement program; however, to our knowledge, there has not been a direct comparison of the quality of care between patients hospitalized at participating hospitals and those at nonparticipating hospitals. OBJECTIVE: To contrast quality of stroke care measures for patients admitted to hospitals participating and not participating in GWTG-Stroke. DESIGN, SETTING, AND PARTICIPANTS: Subpopulation of 546 participants with ischemic stroke occurring during a 9-year follow-up of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a population-based cohort study of 30 239 randomly selected black and white participants 45 years and older recruited between 2003 and 2007. Of those with stroke, 207 (36%) were treated in a hospital participating in GWTG-Stroke and 339 in a nonparticipating hospital. Data were analyzed between July 29, 2017, and April 17, 2018. MAIN OUTCOMES AND MEASURES: Quality of care measures including use of tissue plasminogen activator, performance of swallowing evaluation, antithrombotic use in first 48 hours, lipid profile assessment, discharge receiving antithrombotic therapy, discharge receiving a statin, neurologist evaluation, providing weight loss and exercise counseling, education on stroke risk factors and warning signs, and assessment for rehabilitation. RESULTS: Participants treated at participating hospitals had a mean (SD) age of 74 (8) years and 100 of 207 were men (48%), while those seen at nonparticipating hospitals had a mean (SD) age of 73 (9) years, and 161 of 339 were men (48%). Those seen in participating hospitals were more likely to receive 5 of 10 evidence-based interventions recommended for patients hospitalized with ischemic stroke, including receiving tissue plasminogen activator (RR, 3.74; 95% CI, 1.65-8.50), education on risk factors (RR, 1.54; 95% CI, 1.16-2.05), having an evaluation for swallowing (RR, 1.25; 95% CI, 1.04-1.50), a lipid evaluation (RR, 1.18; 95% CI, 1.05-1.32), and an evaluation by a neurologist (RR, 1.12; 95% CI, 1.05-1.20). Those seen in participating hospitals received a mean of 5.4 (95% CI, 5.2-5.6) interventions compared with 4.8 (95% CI, 4.6-5.0) in nonparticipating hospitals (P &lt; .001). CONCLUSIONS AND RELEVANCE: These data collected independently of the GWTG-Stroke program document improved stroke care for patients with ischemic stroke hospitalized at participating hospitals.

Published
2018
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21. Estimated Impact of Emergency Medical Service Triage of Stroke Patients on Comprehensive Stroke Centers: An Urban Population-Based Study.

Author

Katz, Brian S., Adeoye, Opeolu, Sucharew, Heidi, Broderick, Joseph P., McMullan, Jason, Khatri, Pooja, Widener, Michael, Alwell, Kathleen S., Moomaw, Charles J., Kissela, Brett M., Flaherty, Matthew L., Woo, Daniel, Ferioli, Simona, Mackey, Jason, Martini, Sharyl, De Los Rios la Rosa, Felipe, and Kleindorfer, Dawn O.

Published
2017
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24. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association.

Author

Towfighi, Amytis, Ovbiagele, Bruce, El Husseini, Nada, Hackett, Maree L., Jorge, Ricardo E., Kissela, Brett M., Mitchell, Pamela H., Skolarus, Lesli E., Whooley, Mary A., Williams, Linda S., and American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research

Published
2017
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26. Prehospital neurological deterioration in stroke

Author

Slavin, Sabreena J, Sucharew, Heidi, Alwell, Kathleen, Moomaw, Charles J, Woo, Daniel, Adeoye, Opeolu, Flaherty, Matthew L, Ferioli, Simona, McMullan, Jason, Mackey, Jason, De Los Rios La Rosa, Felipe, Martini, Sharyl, Kissela, Brett M, and Kleindorfer, Dawn O

Abstract

Background and purposePatients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND).MethodsAmong the Greater Cincinnati/Northern Kentucky region (population ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival.ResultsOf 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61–83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND.ConclusionHaemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.

Published
2018
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27. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes

Author

Malik, Rainer, Chauhan, Ganesh, Traylor, Matthew, Sargurupremraj, Muralidharan, Okada, Yukinori, Mishra, Aniket, Rutten-Jacobs, Loes, Giese, Anne-Katrin, van der Laan, Sander W., Gretarsdottir, Solveig, Anderson, Christopher D., Chong, Michael, Adams, Hieab H. H., Ago, Tetsuro, Almgren, Peter, Amouyel, Philippe, Ay, Hakan, Bartz, Traci M., Benavente, Oscar R., Bevan, Steve, Boncoraglio, Giorgio B., Brown, Robert D., Butterworth, Adam S., Carrera, Caty, Carty, Cara L., Chasman, Daniel I., Chen, Wei-Min, Cole, John W., Correa, Adolfo, Cotlarciuc, Ioana, Cruchaga, Carlos, Danesh, John, de Bakker, Paul I. W., DeStefano, Anita L., den Hoed, Marcel, Duan, Qing, Engelter, Stefan T., Falcone, Guido J., Gottesman, Rebecca F., Grewal, Raji P., Gudnason, Vilmundur, Gustafsson, Stefan, Haessler, Jeffrey, Harris, Tamara B., Hassan, Ahamad, Havulinna, Aki S., Heckbert, Susan R., Holliday, Elizabeth G., Howard, George, Hsu, Fang-Chi, Hyacinth, Hyacinth I., Ikram, M. Arfan, Ingelsson, Erik, Irvin, Marguerite R., Jian, Xueqiu, Jiménez-Conde, Jordi, Johnson, Julie A., Jukema, J. Wouter, Kanai, Masahiro, Keene, Keith L., Kissela, Brett M., Kleindorfer, Dawn O., Kooperberg, Charles, Kubo, Michiaki, Lange, Leslie A., Langefeld, Carl D., Langenberg, Claudia, Launer, Lenore J., Lee, Jin-Moo, Lemmens, Robin, Leys, Didier, Lewis, Cathryn M., Lin, Wei-Yu, Lindgren, Arne G., Lorentzen, Erik, Magnusson, Patrik K., Maguire, Jane, Manichaikul, Ani, McArdle, Patrick F., Meschia, James F., Mitchell, Braxton D., Mosley, Thomas H., Nalls, Michael A., Ninomiya, Toshiharu, O’Donnell, Martin J., Psaty, Bruce M., Pulit, Sara L., Rannikmäe, Kristiina, Reiner, Alexander P., Rexrode, Kathryn M., Rice, Kenneth, Rich, Stephen S., Ridker, Paul M., Rost, Natalia S., Rothwell, Peter M., Rotter, Jerome I., Rundek, Tatjana, Sacco, Ralph L., Sakaue, Saori, Sale, Michele M., Salomaa, Veikko, Sapkota, Bishwa R., Schmidt, Reinhold, Schmidt, Carsten O., Schminke, Ulf, Sharma, Pankaj, Slowik, Agnieszka, Sudlow, Cathie L. M., Tanislav, Christian, Tatlisumak, Turgut, Taylor, Kent D., Thijs, Vincent N. S., Thorleifsson, Gudmar, Thorsteinsdottir, Unnur, Tiedt, Steffen, Trompet, Stella, Tzourio, Christophe, van Duijn, Cornelia M., Walters, Matthew, Wareham, Nicholas J., Wassertheil-Smoller, Sylvia, Wilson, James G., Wiggins, Kerri L., Yang, Qiong, Yusuf, Salim, Bis, Joshua C., Pastinen, Tomi, Ruusalepp, Arno, Schadt, Eric E., Koplev, Simon, Björkegren, Johan L. M., Codoni, Veronica, Civelek, Mete, Smith, Nicholas L., Trégouët, David A., Christophersen, Ingrid E., Roselli, Carolina, Lubitz, Steven A., Ellinor, Patrick T., Tai, E. Shyong, Kooner, Jaspal S., Kato, Norihiro, He, Jiang, van der Harst, Pim, Elliott, Paul, Chambers, John C., Takeuchi, Fumihiko, Johnson, Andrew D., Sanghera, Dharambir K., Melander, Olle, Jern, Christina, Strbian, Daniel, Fernandez-Cadenas, Israel, Longstreth, W. T., Rolfs, Arndt, Hata, Jun, Woo, Daniel, Rosand, Jonathan, Pare, Guillaume, Hopewell, Jemma C., Saleheen, Danish, Stefansson, Kari, Worrall, Bradford B., Kittner, Steven J., Seshadri, Sudha, Fornage, Myriam, Markus, Hugh S., Howson, Joanna M. M., Kamatani, Yoichiro, Debette, Stephanie, and Dichgans, Martin

Abstract

Stroke has multiple etiologies, but the underlying genes and pathways are largely unknown. We conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 cases and 454,450 controls) and discovered 22 new stroke risk loci, bringing the total to 32. We further found shared genetic variation with related vascular traits, including blood pressure, cardiac traits, and venous thromboembolism, at individual loci (n= 18), and using genetic risk scores and linkage-disequilibrium-score regression. Several loci exhibited distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology, with prioritization of risk variants and genes accomplished through bioinformatics analyses using extensive functional datasets. Stroke risk loci were significantly enriched in drug targets for antithrombotic therapy.

Published
2018
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29. Withdrawal of Antithrombotic Agents and the Risk of Stroke.

Author

Wagner, Monica L., Khoury, Jane C., Alwell, Kathleen, Rademacher, Eric, Woo, Daniel, Flaherty, Matthew L., Anderson, Aaron M., Adeoye, Opeolu, Ferioli, Simona, Kissela, Brett M., Kleindorfer, Dawn, and Broderick, Joseph P.

Abstract

Background and Purpose: Antithrombotic medications are effective for ischemic stroke prevention, but stoppage of these medications is associated with an increased risk of thromboembolism. The frequency of antithrombotic withdrawal in the general population is unknown.Methods: We conducted a random phone sample of 2036 households in the Greater Cincinnati metropolitan area, representative of the stroke population by age, sex, and race, to determine the frequency of antithrombotic medication use and stoppage by physicians for medically indicated procedures.Results: Sixty-two percent of survey respondents reported that they were on an antithrombotic medication. Ten percent of participants reported that they had stopped taking their medication within the past 60 days for a medically indicated intervention. Of those who stopped taking the medication, it was more common for persons taking an anticoagulant to stop their medication (20%) than those taking an antiplatelet agent (9%). Colonoscopies and orthopedic surgeries were the most common reasons for withdrawal of antiplatelet agents, whereas orthopedic and vascular surgeries were the most common reason for withdrawal of anticoagulants.Conclusions: Recommended discontinuation of antithrombotic medication for surgical or diagnostic procedures is common practice for persons in the community representative of a stroke population. Because stoppage of these medications is associated with an increased risk of thromboembolic stroke, further clinical trials are needed to determine best management practices in this setting. [ABSTRACT FROM AUTHOR]

Published
2016
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30. Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study.

Author

Madsen, Tracy E., Sucharew, Heidi, Katz, Brian, Alwell, Kathleen A., Moomaw, Charles J., Kissela, Brett M., Flaherty, Matthew L., Woo, Daniel, Khatri, Pooja, Ferioli, Simona, Mackey, Jason, Martini, Sharyl, De Los Rios La Rosa, Felipe, and Kleindorfer, Dawn

Abstract

Background: Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship.Methods: Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age.Results: 1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI .78-1.28). This did not change across age or NIHSS categories.Conclusions: After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women. [ABSTRACT FROM AUTHOR]

Published
2016
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37. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Author

Towfighi, Amytis, Ovbiagele, Bruce, El Husseini, Nada, Hackett, Maree L., Jorge, Ricardo E., Kissela, Brett M., Mitchell, Pamela H., Skolarus, Lesli E., Whooley, Mary A., and Williams, Linda S.

Abstract

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.

Published
2017
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39. Abstract TP161: Predictors Of Undiagnosed Risk Factors For Cerebrovascular Ischemic Events: A Population-based Study

Author

Weil, Erika L, Ding, Lili, Khoury, Jane C, Kissela, Brett M, Alwell, Kathleen, Woo, Daniel, De Los Rios La Rosa, Felipe, Mackey, Jason, Ferioli, Simona, Mistry, Eva, Demel, Stacie L, Coleman, Elisheva R, Jasne, Adam S, Slavin, Sabreena J, Walsh, Kyle, Star, Michael, Haverbusch, Mary, and Kleindorfer, Dawn O

Abstract

Introduction:Primary prevention reduces the burden of acute ischemic stroke (AIS), yet cerebrovascular risk factors (RF) remain underdiagnosed in certain populations. We aimed to identify predictors of undiagnosed RF among patients with cerebrovascular ischemic events in a large bi-racial population.Methods:Individuals 20 years and older with an incident TIA or AIS from the population-based Greater Cincinnati/Northern Kentucky 2015 stroke study period were screened for inclusion. We included all hospital ascertained, physician-verified cases of AIS and TIAs. Outpatient and ED-only cases were excluded. Abstracted medical record data included determination of newly diagnosed hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD) or atrial fibrillation (AF). Multivariable models were used to identify predictors for each undiagnosed RF. Model variables included: age, sex, race, insurance status and number of cerebrovascular RF (additionally including coronary artery disease and smoking).Results:A total of 1604 ischemic events were included (1485 stroke, 119 TIA) with 52.9% female; 22.4% Black; median age 70 (IQR 59, 82)). Only 6% (n=102) had no history of RF. The prevalence of each undiagnosed RF was: HTN 4.1%; HLD 7.9%; DM 3.1%; AF 3.2%. In unadjusted bivariate analysis, uninsured/unknown status was predictive of undiagnosed HTN (OR = 3.97, 95% CI 1.48, 10.68; p=.006) and HLD (OR=5.53, 95% CI 2.68, 11.4; p<.0001). After adjustment, insurance status remained a predictor for only undiagnosed HLD (Table 1). No relationship was found with race.Conclusions:The most consistent predictor for an undiagnosed RF was absence of other RF and lack of insurance, both suggestive of suboptimal cardiovascular screening in this population. Further studies assessing known but undertreated RF and socioeconomic factors could be of benefit.

Published
2023
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40. Abstract WMP5: How Do Clinical Trial Exclusion Criteria Impact The Inclusivity Of Clinical Trials?

Author

Kleindorfer, Dawn O, Stanton, Robert J, Sucharew, Heidi, Broderick, Joseph P, Khatri, Pooja, Haverbusch, Mary, Herbers, Logan, Alwell, Kathleen, Robinson, David, ferioli, simona, Flaherty, Matthew L, Woo, Daniel, Demel, Stacie, De Los Rios La Rosa, Felipe, Mackey, Jason, Mistry, Eva, Jasne, Adam, Slavin, Sabreena, MARTINI, SHARYL, Walsh, Kyle, Adeoye, Opeolu M, Star, Michael, and Kissela, Brett M

Abstract

Intro:Enrolling women and under-represented minorities into clinical trials is a top priority for the stroke community. Common trial exclusions for medical conditions or demographics may negatively impact enrollment for these groups. We sought to describe the potential impact that various exclusion criteria have on trial eligibility of ischemic stroke (IS) patients by race and sex within the large, biracial Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) population.Methods:The GCNKSS is a population-based study of 1.3 million people living in a 5-county area of southern Ohio/ Northern Kentucky. During 7/1/14-12/31/15 for blacks, and 2015 for whites, we captured all hospitalized ischemic strokes by screening ICD-9 codes 430-436 and ICD10 codes I60-I68, and G45-46. Commonly used exclusion criteria from stroke clinical trials were applied to the GCNKSS IS population, and were compared by sex and race. All comparisons were evaluated with chi-square test and corrected for multiple comparisons, as necessary.Results:In 2014-2015, there were 2806 ischemic stroke patients, which were 53% female, and 30% black. Table 1 presents common clinical trial exclusion criteria and the % excluded among IS patients, stratified by sex and race. Every trial exclusion evaluated had significant differences by sex, race, or both.Discussion:Within our population, we found that commonly-used age and disability clinical trial exclusion criteria exclude more women than men, and exclusion of milder strokes affects more men than women. Blood pressure, renal function, and early arrival time criteria exclude more blacks than whites, while older age exclude more whites than blacks. Optimal clinical trial design should be informed by epidemiology data to ensure representation of underrepresented populations in clinical trials. We will continue to provide epidemiology feedback on acute trial exclusion criteria to NIH StrokeNet proposals in the future.

Published
2023
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41. Abstract WP176: Prior TIAs Among Patients With Ischemic Stroke In The Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS)

Author

Madsen, Tracy E, Khoury, Jane C, Haverbusch, Mary, Adeoye, Opeolu M, Coleman, Elisheva R, De Los Rios La Rosa, Felipe, Demel, Stacie L, Ferioli, Simona, Flaherty, Matthew L, Jasne, Adam, Khatri, Pooja, Mackey, Jason, Martini, Sharyl R, Mistry, Eva, Slavin, Sabreena, Star, Michael, Walsh, Kyle B, Woo, Daniel, Broderick, Joseph P, Kissela, Brett M, and Kleindorfer, Dawn O

Abstract

Background:TIAs serve as an opportunity to identify and modify risk factors and to prevent future events. Given known epidemiologic differences in strokes by race and sex, our objective was to investigate the rates of prior TIAs among those with incident ischemic stroke (IS) in the GCNKSS.Methods:We included all physician adjudicated, incident IS among adults age ≥20 years in the GCNKSS, a population-based stroke surveillance study in a 5-county region of southern Ohio/ northern Kentucky, in 2005, 2010, and 2015. We calculated the frequency of cases in which a TIA (sudden onset of focal neurologic symptoms lasting ≤ 24 hours) was documented in the 365 days prior to IS. Frequencies and proportions of prior TIA were compared by sex, race, and age, and location at which patients sought care for their TIA was described. Finally, multivariable logistic regression was performed to investigate demographic and clinical predictors of cases in which TIA preceded stroke; covariates were chosen a priori.Results:We included 5310 IS events; mean age was 69.7 (SD 14.8) years, 54.7% were female, and 20.4% were Black. A total of 351 patients (6.6%) had a documented TIA the year preceding their IS. Overall, 42.2% did not seek care for their TIA, 21.6% called 911 and/or came to the ED, 6.0% saw a PCP, and 6.6% sought other care. In 22.5% of cases, location of care was unknown. In adjusted results, older age, female sex, history of hypertension, and CAD were associated with having had a prior TIA, while Black race was not. NIHSS was inversely associated with prior TIA (Table). Prior TIAs were similar between study years.Conclusions:We conservatively estimate that ≥ 6% of patients with first-ever IS had a TIA in the preceding year, though underreporting is likely. Many patients did not report seeking care for the TIA, suggesting missed opportunities for risk factor modification. Further research is needed to understand the implications of sex and race differences in frequencies of prior TIA.

Published
2023
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42. Abstract WP35: Neighborhood Effects On Knowledge Of Stroke Risk Factors And Stroke Warning Signs

Author

Nobel, Lisa, Rasnick, Erika, Ding, Lili, Robinson, David, Ayala, Felipe, Kissela, Brett M, and Kleindorfer, Dawn O

Abstract

Background:Low socio-economic status has been associated with worse stroke outcomes and longer arrival times to the ED.Objective:To determine whether stroke knowledge is different by neighborhood and if neighborhood socio-economic status (NSES) predicts knowledge of stroke risk factors (RF) or stroke warning signs (WS).Methods:A survey was done in the Greater Cincinnati Northern Kentucky Region in 2016 where participants were targeted to match those of ischemic stroke patients within the same population. The participants were asked open-ended questions regarding stroke WS and RFs. Participants also provided their zip codes. NSES was determined based on zip code and census data. NSES was determined using a previously validated index and divided into quartiles. We used regression to determine the association between NSES and only being able to name 0-1 RF or WS.Results:There were 1902 participants in the surveys with non-missing geographic data who lived in 96 different zip codes. Participants were 66.8±16.4 years old, 56.2% were female, 24.4% were black and 36.0% had less than a HS education. About 20% of participants were unable to name one stroke risk factor or one warning sign. There was substantial heterogeneity of stroke knowledge by zip code (Figure 1). There was no significant association between NSES and knowledge of stroke WS. After adjustment for age, sex, and race, participants who lived in neighborhoods in the lowest quartile of NSES were more likely to be only able to name 0-1 RFs when compared to all other neighborhoods (Lowest Quartile of NSES OR 1.45 (95% CI 1.06-1.98)).Conclusion:We identified geographic disparities of stroke knowledge in a well-defined population, emphasizing the need for targeting public health interventions towards areas most in need. NSES accounted for some of the disparities in stroke RF knowledge, but not stroke WS knowledge.1

Published
2023
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43. Abstract WP43: Characteristics And Management Of Hospitalized Retinal Artery Occlusion Patients In The Era Of Updated Guidelines: A Population-based Study

Author

LaPorta, Joseph C, Robinson, David, Stanton, Robert J, Kleindorfer, Dawn O, Ferioli, Simona, Aziz, Yasmin, Sucharew, Heidi, Haverbusch, Mary, and Kissela, Brett M

Abstract

Background:Retinal artery occlusion (RAO) is a stroke equivalent that causes significant morbidity. There has been growing emphasis on urgent in-hospital evaluation of these patients, both to facilitate potential thrombolytic therapy and expedite workup; however, little is known regarding its effect on systems of care. We thus examined presenting characteristics and management of hospitalized RAO patients using the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS).Methods:The GCNKSS is a population-based study of stroke in a 5-county region with a population of 1.3 million representative of the USA in terms of Black race, income, and education. All cases of RAO among Black individuals from July 2019-December 2020 and among White individuals from 2020 were chart abstracted using ICD codes. All cases underwent physician adjudication. Demographic and clinical data were recorded.Results:We identified 57 hospitalizations with acute RAO among 55 patients. Characteristics of their hospitalization and demographics are shown (Table). Notably, 19% (11/57) of patients presented in a thrombolytic window of ≤3.5 and average time from symptom onset to evaluation was 17 hours. Most patients initially interacted with a subspecialist (53%) and presented to the ED in delayed fashion. One patient received thrombolytic therapy, four (7%) patients underwent carotid revascularization, and no patients had newly identified atrial fibrillation, cardiac thrombus, or endocarditis.Discussion:Our population-based study found only a minority of patients presented within a thrombolytic window, suggesting that systems of care need to promote more rapid evaluation of these patients. Very few patients received select intervention, but the high impact of carotid revascularization may warrant urgent evaluation of even low risk patients. Further study of long-term outcomes in this patient population is called for.

Published
2023
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44. Abstract 71: Temporal Trends In 30-day And 5-year Stroke Case Fatality Rates

Author

Robinson, David, Ding, Lili, Khoury, Jane C, Stanton, Robert J, Alwell, Kathleen, Khatri, Pooja, Adeoye, Opeolu M, Broderick, Joseph P, Mackey, Jason, Mistry, Eva, Star, Michael, Martini, Sharyl R, Haverbusch, Mary, Ferioli, Simona, Woo, Daniel, De Los Rios La Rosa, Felipe, Demel, Stacie L, Flaherty, Matthew L, Slavin, Sabreena, Walsh, Kyle B, Coleman, Elisheva R, Jasne, Adam, Kleindorfer, Dawn O, and Kissela, Brett M

Abstract

Background:Previous studies spanning the 1990s-2010s have inconsistently identified a decline in 30-day stroke case-fatality rate (CFR), and little is known about trends in longer term stroke CFR over that period. We studied temporal trends in 30-day and 5-year CFRs in the well-defined Greater Cincinnati/Norther Kentucky (GCNK) stroke population.Methods:The NIH-funded GCNK Stroke Study is a population-based study conducted in a 5-county region that is representative of the USA in terms of Black race, income, and education. The study ascertained all strokes in 1993/4, 1999, 2005, 2010, and 2015 using well-validated methods. All stroke subtypes were included: ischemic strokes (IS), intracerebral hemorrhages (ICH), and subarachnoid hemorrhages (SAHs). Deaths were identified via the National Death Index. Cox proportional hazards models were used to assess all-cause fatality, by subtype, to examine temporal trends adjusting for age, sex, and race.Results:A total of 10372 stroke cases were ascertained over the five study periods (8428 IS, 443 SAH, and 1501 ICH). IS patients did not demonstrate a decline in 30-day CFRs over time, but did show a nonsignificant decrease in 5-year CFR. Among IS patients, female sex was associated with a lower 5-year CFR, whereas Black individuals had a lower 30-day CFR but a higher 5-year CFR. For ICH, there was a small increase in both 30-day and 5-year CFR in later study periods, although this did not reach significance in all years. SAH showed a lower 30-day CFR over time but no change in 5-year CFR. Older age was associated with a higher 30-day and 5-year CFR in all subtypes.Discussion:Despite widespread advances in post-stroke care, adjusted 5-year CFR has not clearly improved for any stroke subtype and may have slightly worsened for ICH. 30-day CFR has shown a modest improvement among SAH patients. Future studies should investigate why Black individuals with IS experience lower early CFR but a higher late CFR.

Published
2023
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45. Abstract WMP107: Temporal Trends In Public Awareness Of Stroke: 1996-2021

Author

Robinson, David, Khoury, Jane C, Ding, Lili, Rademacher, Eric, Alwell, Kathleen, Broderick, Joseph P, Stanton, Robert J, Kissela, Brett M, and Kleindorfer, Dawn O

Abstract

Background:Knowledge of stroke risk factors (RF) and warning signs (WS) may improve adherence to primary stroke prevention and encourage more rapid presentation after symptom onset. As a result, improving stroke knowledge has been a major public health focus. We sought to study trends in stroke knowledge between 1996 and 2021 in a well-defined population.Methods:Surveys were conducted in 1996, 2000, 2005, 2011, 2016, and 2021 in the 5-county Greater Cincinnati Northern Kentucky region, a population of 1.3 million that reflects the USA in terms of Black race, income, and educational attainment. Respondents were selected to reflect the age, race and sex distribution of the local ischemic stroke population. Potential subjects were contacted using random-digit dialing (with adjustment for cell phone use after 2005) and asked open-ended questions regarding stroke WS and RF knowledge. Correct answers for all years were determined based upon current AHA guidelines and public health messaging. Trends in knowledge were then evaluated over time adjusting for age, Race, sex, and education. Multiple logistic regression models and a cumulative model were used for analysis.Results:Over the 25-year period, 12,322 surveys were completed. After adjustment for age, sex, Race, and education, RF and WS knowledge significantly increased between 1996 and 2021 (P<0.0001), but this was not consistent across years (Figure). The percentage of participants that could identify at least two WS improved significantly in 2000 and then again in 2011. Stroke WS knowledge was then stagnant in 2016 and worsened slightly in 2021. Knowledge of at least two RFs steadily improved from 1996 to 2011, but then declined modestly in 2016 and was stagnant in 2021.Discussion:While stroke RF and WS knowledge has overall improved since 1996, knowledge remains suboptimal and some gains may have been lost in recent years. More research on the most effective methods for improving stroke awareness is needed.

Published
2023
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46. Abstract 68: Socioeconomic Factors Associated With Ems-documented Stroke Chief Complaints In The Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS)

Author

Madsen, Tracy E, Sucharew, Heidi, Haverbusch, Mary, Adeoye, Opeolu M, Coleman, Elisheva R, Demel, Stacie L, De Los Rios La Rosa, Felipe, Ferioli, Simona, Jasne, Adam, Li, James, Mackey, Jason, Mistry, Eva, Slavin, Sabreena, Star, Michael, Walsh, Kyle B, Woo, Daniel, Kissela, Brett M, and Kleindorfer, Dawn O

Abstract

Background:Accurate identification of stroke by EMS is necessary for triage and pre-notification within stroke systems of care. Our objective was to describe disparities in the documentation of stroke as the patient’s chief complaint (CC) by EMS in a large population-based stroke study.Methods:We included physician-adjudicated strokes and TIAs occurring among adults ≥18 years old in 2015 in the GCNKSS study population, based in a 5-county area of Southern Ohio/Northern Kentucky. Strokes in which EMS was not used and events occurring in the hospital, during EMS transport, at an unknown location, or outside the study region were excluded. The documented CC by EMS (stroke/CVA, MI, seizure, fall, weakness/numbness, headache, or other) were compared between race/sex subgroups. Sequential multivariable logistic regression was performed to identify associations between race, sex, and social determinants of health with an EMS-documented stroke CC. Social determinants included living arrangement and census tract social deprivation index (SDI).Results:A total of 1451 stroke/TIA events were included. White women had the highest proportion of EMS-documented stroke CCs (56%), more than Black women (48%), White men (45%), and Black men (42%), (p=0.02). Black race was inversely associated with an EMS-documented stroke CC in initial models but was collinear with SDI and no longer significant when SDI was included. In the full model, age, previous stroke, and living with others were associated with an EMS-documented stroke CC, while SDI and CAD were inversely associated with EMS-documented stroke CCs. (Table)Conclusion:Patients living in census tracts characterized by social deprivation were less likely to have EMS-documented stroke CCs, suggesting differences in either patient or EMS recognition of stroke. Further work is needed to explore potential confounders including EMS protocols and to improve identification of stroke by patients and EMS providers.

Published
2023
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47. Abstract TMP106: Decline In The Severity Of Hospitalized Ischemic Stroke 2005-2015: The Greater Cincinnati/Northern Kentucky Stroke Study

Author

Reeves, Mathew J, Ding, Lili, Khoury, Jane C, Robinson, David, Stanton, Robert J, Alwell, Kathleen S, Haverbusch, Mary, Woo, Daniel, Ferioli, Simona, Adeoye, Opeolu M, Flaherty, Matthew L, Mackey, Jason, De Los Rios La Rosa, Felipe, Khatri, Pooja, Demel, Stacie, Coleman, Elisheva R, Martini, Sharyl, Mistry, Eva, Jasne, Adam, Slavin, Sabreena, Star, Michael, Walsh, Kyle, Kleindorfer, Dawn O, and Kissela, Brett M

Abstract

Background:Monitoring changes in ischemic stroke severity at the population level is important as changes in risk factors and clinical treatments could influence stroke severity. We describe trends in the distribution of NIHSS across 3 time periods in a population-based epidemiologic stroke study.Methods:In 2005, 2010, and 2015 all adult acute ischemic strokes occurring within the Greater Cincinnati area presenting to 15 hospitals were ascertained using discharge codes (ICD-9 433-436; IDC-10 I63-I68, G45-46). Following physician verification, confirmed ischemic stroke cases underwent chart abstraction including estimation of a retrospective (rNIHSS) score at presentation. Descriptive statistics (rNIHSS median, IQR) were generated by survey year, demographics, and medical history. Using a binary definition of stroke severity (median rNIHSS score &gt 4 versus &lt 4), multivariable logistic regression was used to estimate changes in stroke severity over time, adjusting for potential confounders. Random effects were used to account for multiple admissions occurring in the same subject.Results:The number of ischemic stroke admissions in the 2005, 2010, and 2015 surveys was 1778, 1903, and 1933, respectively (Table). The median (IQR) rNIHSS scores were 3 (2-7), 3 (1-6), and 2 (1-6) across the 3 surveys, respectively; the proportion of admissions with rNIHSS &gt 4 was 48%, 39% and 37%, respectively. After adjusting for demographics, medical history and pre-stroke function, compared to 2005, the odds ratio for more severe stroke was 0.69 (95% CI= 0.60-0.79, p=0.001) in 2010 and 0.63 (95% CI= 0.55-0.73, p=0.001) in 2015.Conclusions:In this population- based study there was a statistically significant change in the severity of ischemic stroke hospitalizations with increases in the proportion of milder strokes over time. Potential reasons for this change need to be explored but could include changes in risk factors, clinical treatments or diagnostic approach.

Published
2023
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49. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Wang, Haidong, Naghavi, Mohsen, Allen, Christine, Barber, Ryan M, Bhutta, Zulfiqar A, Carter, Austin, Casey, Daniel C, Charlson, Fiona J, Chen, Alan Zian, Coates, Matthew M, Coggeshall, Megan, Dandona, Lalit, Dicker, Daniel J, Erskine, Holly E, Ferrari, Alize J, Fitzmaurice, Christina, Foreman, Kyle, Forouzanfar, Mohammad H, Fraser, Maya S, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Graetz, Nicholas, Haagsma, Juanita A, Hay, Simon I, Huynh, Chantal, Johnson, Catherine O, Kassebaum, Nicholas J, Kinfu, Yohannes, Kulikoff, Xie Rachel, Kutz, Michael, Kyu, Hmwe H, Larson, Heidi J, Leung, Janni, Liang, Xiaofeng, Lim, Stephen S, Lind, Margaret, Lozano, Rafael, Marquez, Neal, Mensah, George A, Mikesell, Joe, Mokdad, Ali H, Mooney, Meghan D, Nguyen, Grant, Nsoesie, Elaine, Pigott, David M, Pinho, Christine, Roth, Gregory A, Salomon, Joshua A, Sandar, Logan, Silpakit, Naris, Sligar, Amber, Sorensen, Reed J D, Stanaway, Jeffrey, Steiner, Caitlyn, Teeple, Stephanie, Thomas, Bernadette A, Troeger, Christopher, VanderZanden, Amelia, Vollset, Stein Emil, Wanga, Valentine, Whiteford, Harvey A, Wolock, Timothy, Zoeckler, Leo, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abera, Semaw Ferede, Abreu, Daisy M X, Abu-Raddad, Laith J, Abyu, Gebre Yitayih, Achoki, Tom, Adelekan, Ademola Lukman, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Lami, Faris Hasan Al, Alabed, Samer, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Alasfoor, Deena, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alegretti, Miguel Angel, Aleman, Alicia V, Alemu, Zewdie Aderaw, Alexander, Lily T, Alhabib, Samia, Ali, Raghib, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amegah, Adeladza Kofi, Ameh, Emmanuel A, Amini, Heresh, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Benjamin O, Anderson, Gregory M, Antonio, Carl Abelardo T, Aregay, Atsede Fantahun, Ärnlöv, Johan, Arsenijevic, Valentina S Arsic, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Azzopardi, Peter, Bacha, Umar, Badawi, Alaa, Bahit, Maria C, Balakrishnan, Kalpana, Banerjee, Amitava, Barac, Aleksandra, Barker-Collo, Suzanne L, Bärnighausen, Till, Barregard, Lars, Barrero, Lope H, Basu, Arindam, Basu, Sanjay, Bayou, Yibeltal Tebekaw, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Belay, Haileeyesus Adamu, Bell, Brent, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhala, Neeraj, Bhalla, Ashish, Biadgilign, Sibhatu, Bikbov, Boris, Abdulhak, Aref A Bin, Biroscak, Brian J, Biryukov, Stan, Bjertness, Espen, Blore, Jed D, Blosser, Christopher D, Bohensky, Megan A, Borschmann, Rohan, Bose, Dipan, Bourne, Rupert R A, Brainin, Michael, Brayne, Carol E G, Brazinova, Alexandra, Breitborde, Nicholas J K, Brenner, Hermann, Brewer, Jerry D, Brown, Alexandria, Brown, Jonathan, Brugha, Traolach S, Buckle, Geoffrey Colin, Butt, Zahid A, Calabria, Bianca, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Carapetis, Jonathan R, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Catalá-López, Ferrán, Cavalleri, Fiorella, Cercy, Kelly, Cerda, Jorge, Chen, Wanqing, Chew, Adrienne, Chiang, Peggy Pei-Chia, Chibalabala, Mirriam, Chibueze, Chioma Ezinne, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Cirillo, Massimo, Cohen, Aaron J, Colistro, Valentina, Colomar, Mercedes, Colquhoun, Samantha M, Cooper, Cyrus, Cooper, Leslie Trumbull, Cortinovis, Monica, Cowie, Benjamin C, Crump, John A, Damsere-Derry, James, Danawi, Hadi, Dandona, Rakhi, Daoud, Farah, Darby, Sarah C, Dargan, Paul I, das Neves, José, Davey, Gail, Davis, Adrian C, Davitoiu, Dragos V, de Castro, E Filipa, de Jager, Pieter, Leo, Diego De, Degenhardt, Louisa, Dellavalle, Robert P, Deribe, Kebede, Deribew, Amare, Dharmaratne, Samath D, Dhillon, Preet K, Diaz-Torné, Cesar, Ding, Eric L, dos Santos, Kadine Priscila Bender, Dossou, Edem, Driscoll, Tim R, Duan, Leilei, Dubey, Manisha, Duncan, Bruce Bartholow, Ellenbogen, Richard G, Ellingsen, Christian Lycke, Elyazar, Iqbal, Endries, Aman Yesuf, Ermakov, Sergey Petrovich, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Faghmous, Imad D A, Fahimi, Saman, Faraon, Emerito Jose Aquino, Farid, Talha A, Farinha, Carla Sofia e Sa, Faro, André, Farvid, Maryam S, Farzadfar, Farshad, Feigin, Valery L, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Fernandes, Joao C, Fischer, Florian, Fitchett, Joseph R A, Flaxman, Abraham, Foigt, Nataliya, Fowkes, F Gerry R, Franca, Elisabeth Barboza, Franklin, Richard C, Friedman, Joseph, Frostad, Joseph, Fürst, Thomas, Futran, Neal D, Gall, Seana L, Gambashidze, Ketevan, Gamkrelidze, Amiran, Ganguly, Parthasarathi, Gankpé, Fortuné Gbètoho, Gebre, Teshome, Gebrehiwot, Tsegaye Tsewelde, Gebremedhin, Amanuel Tesfay, Gebru, Alemseged Aregay, Geleijnse, Johanna M, Gessner, Bradford D, Ghoshal, Aloke Gopal, Gibney, Katherine B, Gillum, Richard F, Gilmour, Stuart, Giref, Ababi Zergaw, Giroud, Maurice, Gishu, Melkamu Dedefo, Giussani, Giorgia, Glaser, Elizabeth, Godwin, William W, Gomez-Dantes, Hector, Gona, Philimon, Goodridge, Amador, Gopalani, Sameer Vali, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Greaves, Felix, Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gutiérrez, Reyna A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Halasa, Yara A, Hamadeh, Randah Ribhi, Hamidi, Samer, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Havmoeller, Rasmus, Heckbert, Susan R, Heredia-Pi, Ileana Beatriz, Heydarpour, Pouria, Hilderink, Henk B M, Hoek, Hans W, Hogg, Robert S, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Guoqing, Huang, Cheng, Huang, Hsiang, Huiart, Laetitia, Husseini, Abdullatif, Huybrechts, Inge, Huynh, Grace, Iburg, Kim Moesgaard, Innos, Kaire, Inoue, Manami, Iyer, Veena J, Jacobs, Troy A, Jacobsen, Kathryn H, Jahanmehr, Nader, Jakovljevic, Mihajlo B, James, Peter, Javanbakht, Mehdi, Jayaraman, Sudha P, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jimenez-Corona, Aida, Jonas, Jost B, Joshi, Tushar Kant, Kabir, Zubair, Kamal, Ritul, Kan, Haidong, Kant, Surya, Karch, André, Karema, Corine Kakizi, Karimkhani, Chante, Karletsos, Dimitris, Karthikeyan, Ganesan, Kasaeian, Amir, Katibeh, Marzieh, Kaul, Anil, Kawakami, Norito, Kayibanda, Jeanne Françoise, Keiyoro, Peter Njenga, Kemmer, Laura, Kemp, Andrew Haddon, Kengne, Andre Pascal, Keren, Andre, Kereselidze, Maia, Kesavachandran, Chandrasekharan Nair, Khader, Yousef Saleh, Khalil, Ibrahim A, Khan, Abdur Rahman, Khan, Ejaz Ahmad, Khang, Young-Ho, Khera, Sahil, Khoja, Tawfik Ahmed Muthafer, Kieling, Christian, Kim, Daniel, Kim, Yun Jin, Kissela, Brett M, Kissoon, Niranjan, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kolte, Dhaval, Kopec, Jacek A, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Krog, Norun Hjertager, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kudom, Andreas A, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G Anil, Kwan, Gene F, Lal, Aparna, Lal, Dharmesh Kumar, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lam, Jennifer O, Langan, Sinead M, Lansingh, Van C, Larsson, Anders, Laryea, Dennis Odai, Latif, Asma Abdul, Lawrynowicz, Alicia Elena Beatriz, Leigh, James, Levi, Miriam, Li, Yongmei, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Patrick Y, Liu, Shiwei, Liu, Yang, Lo, Loon-Tzian, Logroscino, Giancarlo, Lotufo, Paulo A, Lucas, Robyn M, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Stefan, Machado, Vasco Manuel Pedro, Mackay, Mark T, MacLachlan, Jennifer H, Razek, Hassan Magdy Abd El, Magdy, Mohammed, Razek, Abd El, Majdan, Marek, Majeed, Azeem, Malekzadeh, Reza, Manamo, Wondimu Ayele Ayele, Mandisarisa, John, Mangalam, Srikanth, Mapoma, Chabila C, Marcenes, Wagner, Margolis, David Joel, Martin, Gerard Robert, Martinez-Raga, Jose, Marzan, Melvin Barrientos, Masiye, Felix, Mason-Jones, Amanda J, Massano, João, Matzopoulos, Richard, Mayosi, Bongani M, McGarvey, Stephen Theodore, McGrath, John J, McKee, Martin, McMahon, Brian J, Meaney, Peter A, Mehari, Alem, 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Abstract

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures.

Published
2016
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