Examinando por Materia "Stroke"

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    Anger or emotional upset and heavy physical exertion as triggers of stroke. The INTERSTROKE study
    (European Society of Cardiology, 2022-01-14) Smyth, Andrew; O’Donnell, Martin; Hankey, Graeme J.; Rangarajan, Sumathy; Lopez-Jaramillo, Patricio; Xavier, Denis; Zhang, Hongye; Canavan, Michelle; Damasceno, Albertino; Langhorne, Peter; Avezum, Alvaro; Pogosova, Nana; Oguz, Aytekin; Yusuf, Salim; INTERSTROKE investigators; Masira
    Aims In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population. Methods and results INTERSTROKE was a case–control study of first stroke in 32 countries. Using 13 462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15–1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00–1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40–2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03–2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive. Conclusion Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.
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    Anger or emotional upset and heavy physical exertion as triggers of stroke: The INTERSTROKE study
    (2022-01-14) Smyth, Andrew; O’Donnell, Martin; Hankey, Graeme J.; Rangarajan, Sumathy; Lopez-Jaramillo, Patricio; Xavier, Denis; Zhang, Hongye; Canavan, Michelle; Damasceno, Albertino; Langhorne, Peter; Alvaro, Avezum; Pogosova, Nana; Oguz, Aytekin; Yusuf, Salim; INTERSTROKE investigators; Masira
    Aims In INTERSTROKE, we explored the association of anger or emotional upset and heavy physical exertion with acute stroke, to determine the importance of triggers in a large, international population. Methods and results INTERSTROKE was a case–control study of first stroke in 32 countries. Using 13 462 cases of acute stroke we adopted a case-crossover approach to determine whether a trigger within 1 hour of symptom onset (case period), vs. the same time on the previous day (control period), was associated with acute stroke. A total of 9.2% (n = 1233) were angry or emotional upset and 5.3% (n = 708) engaged in heavy physical exertion during the case period. Anger or emotional upset in the case period was associated with increased odds of all stroke [odds ratio (OR) 1.37, 99% confidence interval (CI), 1.15–1.64], ischaemic stroke (OR 1.22, 99% CI, 1.00–1.49), and intracerebral haemorrhage (ICH) (OR 2.05, 99% CI 1.40–2.99). Heavy physical exertion in the case period was associated with increased odds of ICH (OR 1.62, 99% CI 1.03–2.55) but not with all stroke or ischaemic stroke. There was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time, or day of symptom onset. Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive. Conclusion Acute anger or emotional upset was associated with the onset of all stroke, ischaemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only.
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    Diseño de una Lista de Chequeo Para el Alistamiento Pre Quirúrgico en Procedimientos de Reparación de Aneurisma Cerebral con el uso del Dispositivo Coils
    (Universidad de Santander, 2023-02-24) Hernandez-Reyes, Janeth Sthephany; Contreras-Jaimes, Maria Paula; Gelves-Rodríguez, María Paula; Acevedo-Supelano, Adriana Lucia; Vargas-Rodriguez, Mónica; Pérez-Rodríguez, Angie Paola
    El presente proyecto cuyo propósito principal es, diseñar una lista de chequeo para ofrecer seguridad en el alistamiento previo de una intervención quirúrgica por aneurisma cerebral con dispositivo Coils, tiene como finalidad llevar el control sobre un protocolo quirúrgico para cirugía endovascular. Es importante saber que un aneurisma cerebral es el ensanchamiento anormal de un vaso sanguíneo ubicado en el cerebro, el cual puede desarrollarse por diferentes problemas de salud como un proceso de infección, debilitamiento en la pared vascular, entre otros. Las aneurismas cerebrales se clasifican en Aneurisma sacular, Aneurisma fusiforme y Aneurisma disecante. Las aneurismas cerebrales tienden a causar una ruptura de un vaso sanguíneo, generando complicaciones como un accidente cerebro vascular hemorrágico. El sangrado es un factor de riesgo de alta gravedad, por ende, se recomienda tratarse de forma endovascular con dispositivos como el coils, el cual fue diseñado y aplicado en 1991 por Guglielmi cuyo tratamiento puede ser utilizado en intervenciones de aneurismas rotos y no rotos. El uso de la técnica con coils le brinda al paciente una cirugía de menor traumatismo y menor manipulación de las estructuras. Es importante realizar una intervención quirúrgica oportuna enfatizando en la etapa de planificación realizada por el profesional en instrumentación quirúrgica previo a la cirugía. Para lograr este objetivo se diseñó un instrumento de medición teniendo como base las características de los protocolos pre quirúrgicos existentes, basándose en 4 preguntas principales las cuales recopilaron información acerca del procedimiento quirúrgico sobre aneurisma cerebral por parte de profesionales expertos en el tema. Posteriormente se diseñó la lista de chequeo con las respuestas del cuestionario, finalmente la lista de chequeo fue creada teniendo en cuenta la similitud de elementos que respondieron los participantes y clasificando estos según corresponde.
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    Fase de Alistamiento Para la Adaptación de una Guía de Atención de Fisioterapia Para el Paciente con Accidente Cerebrovascular al Contexto de los Estudiantes de Prácticas Clínicas de la Universidad de Santander de Valledupar
    (universidad de santander, 2023-05-19) Peñaloza-Loperena, Marlene Yalileth; Zarate-Castro, Jose Eduardo; Arocha-Gil, Maria Jose; Gil-Brito, Felicia Dolores; Cabrales-Chogó, Martha Elena; Echavez-Ballesteros, Diana Liseth
    El ACV es un síndrome clínico de origen vascular caracterizado por la aparición de signos y síntomas progresivos debido a la perdida de una función focal, siendo así una causa de incapacidad severa. Se realizó una recolección de datos sobre el motivo de consulta más frecuente en los años 2020 y 2021 en las instituciones de salud con convenio docencia servicio dando como resultado que la patología con más incidencia es el ACV con un 30% en la ciudad de Valledupar, su frecuencia aumenta con la edad y las poblaciones que envejecen. El desarrollo de Guías de práctica clínica basadas en evidencia es una decisión del Sistema General de Seguridad Social con el fin de garantizar la prestación de servicios de salud con calidad, de esta manera se mejora la práctica clínica promoviendo el uso eficiente de los recursos para el manejo fisioterapéutico de dicha patología. Actualmente las instituciones cuentan con guías adoptadas del Ministerio de Salud y Protección Social para garantizar la calidad del servicio de salud, pero continúan en un proceso de mejoramiento de servicios como fisioterapia, donde requiere de procesos de adaptación de las recomendaciones clínicas dadas por el ministerio en contextos donde se desenvuelven los pacientes. 1. Citación: Marlene Yalileth. P., Jose Eduardo. Z., María Jose. A. Fase De Alistamiento Para La Adaptación De Una Guía De Atención De Fisioterapia Para El Paciente Con Accidente Cerebrovascular Al Contexto De Los Estudiantes De Prácticas Clínicas De La Universidad De Santander De Valledupar [Trabajo de grado pregrado]. Universidad de Santander, 2023.
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    Increased plasma levels of total homocysteine but not asymmetric dimethylarginine in hispanic subjects with ischemic stroke frecvi
    (2012-03) Rueda Clausen, Christian F.; Córdoba Porras, A.; Bedoya, G.; Silva Sieger, Federico Arturo; Zarruk, Juan G.; Lopez-Jaramillo, Patricio; Villa, L.A.
    BACKGROUND AND PURPOSE:Despite sharing some metabolic and pathological mechanisms, the reported association between total homocysteine (tHcy), asymmetric dimethylarginine (ADMA) and stroke remains controversial, particularly in Hispanic populations from developing countries in which genetic, socioeconomic, and nutritional factors are different to those described in developed countries. Our objectives were to determine the relationships of these factors to stroke and to each other independent of other cardiovascular risk factors, and to explore potential sex differences. METHODS: This national (Colombia) multicenter case-control study included 238 cases and 238 controls to evaluate traditional and emerging risk factors for ischemic stroke including tHcy and ADMA plasma levels. RESULTS: The median plasma levels of tHcy were 8.48 μM for controls and 10.01 μM for cases (P<0.0001). Plasma levels of tHcy between 12 and 50μM were considered moderate hyperhomocysteinemia (HtHcy). There were no differences in plasma ADMA concentration between groups (P=0.40). Plasma levels of ADMA and creatinine were not correlated (P=0.47). After adjusting for confounding factors, the presence of HtHcy was strongly associated with stroke (OR 8.97; P<0.0001). The adjusted association between HtHcy and stroke in men (OR 9.98) was comparable to that in women (OR 8.98) (P=0.41). CONCLUSIONS: In this Hispanic population, with relatively normal renal function, plasma levels of tHcy but not ADMA were associated with stroke independent of other cardiovascular risk factors.
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    Intervenciones Fisioterapéuticas Dirigidas al Manejo de la Espasticidad en el Miembro Superior Post-ECV: Scoping Review
    (Universidad de Santander, 2023-12-14) Ardila-Murillo, Jose Luis; Uribe-Villamizar, Juan Camilo; Vanegas-Mendoza, July Tatiana; Gonzáles-Silva, María Juliana; Reyes-Pulido, Mabel Margoth; Buitrago-Buitrago, Jhosman Alfonso; Bacca-Ramírez- Odair Alfonso
    La Enfermedad Cerebro Vascular (ECV) ha sido considerada un problema de salud pública a nivel global y local, convirtiéndose en una de las principales causas de admisión hospitalaria y generador de discapacidad principalmente en el adulto mayor. Este aspecto ha generado un alto impacto en los profesionales de la salud que se enfrentan al manejo de las limitaciones en las actividades y restricciones en la participación en los diferentes roles dentro de la sociedad. Lo anterior conduce a los fisioterapeutas a plantear acciones e intervenciones encaminadas a la habilitación, la rehabilitación, el mantenimiento, la optimización y la potencialización del movimiento corporal humano, fundamentadas en el conocimiento científico y tecnológico, con el objetivo principal de brindar una atención integral a los usuarios para lograr una funcionalidad óptima. Dentro de las intervenciones realizadas por los profesionales en fisioterapia existen aquellas dirigidas al manejo de la espasticidad producida post-ECV, la cual es altamente incapacitante y genera cambios estructurales a nivel del sistema musculoesquelético y funcionales en actividades como el alcance funcional y la marcha. En este respecto, esta revisión se enfocó en las intervenciones dirigidas al manejo de la espasticidad post-ECV en el miembro superior parético (MSP), teniendo como premisa que el compromiso funcional se presenta hasta en el 77% de los casos en actividades relevantes como el agarre y la manipulación de objetos.
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    Medidas de Prevención y Factores de Riesgo de ACV en Pacientes Atendidos en el Hospital Universitario Erasmo Meoz en el Periodo 2021B – 2022A
    (Universidad de Santander, 2023-02-23) Bautista-Sepulveda, Neyker Yuslebershon; Antolinez-Nieto, Leidy Johana; Urbina-Contreras, Zulma; Olarte-Ardila, Rafael Alberto; Matamoros-Barreto, Juan Felipe; Uzcategui-Santiago
    Descripción Se entiende el accidente cerebrovascular como un evento súbito con diferente etiología, factores de riesgo predisponentes y síntomas, cuya gravedad y ocurrencia dependen del tipo y el área afectada, convirtiéndose en una de las principales causas de muerte todo el mundo. El objetivo del presente trabajo consiste en analizar la prevalencia, los factores de riesgo y proponer medidas de prevención de ACV en pacientes atendidos en el HUEM en el periodo 2021B a 2022A. Se realizó un estudio descriptivo, observacional de tipo transversal en donde se revisaron las historias clínicas de los pacientes con diagnóstico de ACV que hayan ingresado al HUEM en el periodo 2021B a 2022A para la identificación y análisis de las variables, obteniendo frecuencias y porcentajes que dieron respuesta a los objetivos planteados. Se obtuvo que el tipo de ACV más frecuente fue el isquémico (72%), los factores de riesgo modificables encontrados fueron HTA (77%), DM (30%), IC (25%), FA (21%), tabaquismo (6%), alcohol (1%) y mal estado nutricional (54%); y los no modificables fueron el sexo femenino (53%), la edad entre los 60 a 69 (29,1%) y el antecedente de un ictus previo (5%). Las medidas de prevención están orientadas al diagnóstico, control y seguimiento de las comorbilidades, así como el llevar un estilo de vida saludable que incluya tanto un bienestar físico como emocional. Cita. Bautista - Sepulveda, Neyker Yuslebershon. Antolinez - Nieto, Leidy Johana. Tutor científico: Urbina - Contreras, Zulma. Tutor metodológico: Sánchez – Frank, José Vicente. Wilches – Vega, Juan Diego.(2023). Medidas de Prevención y Factores de Riesgo de ACV en Pacientes Atendidos en el Hospital Universitario Erasmo Meoz en el Periodo 2021B – 2022A. Universidad de Santander.
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    Mendelian Genes and Risk of Intracerebral Hemorrhage and Small-Vessel Ischemic Stroke in Sporadic Cases
    (2017-08) Lopez-Jaramillo, Patricio; Chong, Michael; O’Donnell, Martin J.; Thijs, Vincent; Dans, Antonio; Gómez Arbeláez, Diego; Mondo, Charles; Czlonkowska, Anna; Skowronska, Marta; Oveisgharan, Shahram; Yusuf, Salim; Paré, Guillaume
    Background and Purpose—Mendelian strokes are rare genetic disorders characterized by early-onset small-vessel stroke. Although extensively studied among families with syndromic features, whether these genes affect risk among sporadic cases is unknown. Methods—We sequenced 8 genes responsible for Mendelian stroke in a case–control study of sporadic stroke cases (≤70 years). Participants included 1251 primary stroke cases of small-vessel pathology (637 intracerebral hemorrhage and 614 small-vessel ischemic stroke cases) and 1716 controls from the INTERSTROKE study (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World). Results—Overall, the prevalence of canonical disease-causing mutations was 0.56% in cases and 0.23% in controls (odds ratio=1.89; 95% confidence interval, 0.54–7.57; P=0.33). CADASIL (Cerebral Autosomal Dominant Arteriopathies with Subcortical Infarcts and Leukoencephalopathies) mutations were more frequent among cases (0.48%) than controls (0.23%) but were not significantly associated with stroke risk (odds ratio=2.03; 95% confidence interval, 0.58–8.02; P=0.27). Next, we included all rare nonsynonymous mutations to investigate whether other types of mutations may contribute to stroke risk. Overall, 13.5% of cases and 14.2% of controls were carriers of at least one rare nonsynonymous mutation among the 8 Mendelian stroke genes. Mutation carriers were not at elevated risk of stroke (odds ratio=0.93; 95% confidence interval, 0.75–1.16; P=0.55). Conclusions—In the absence of syndromic features and family history of stroke, screening for Mendelian mutations among small-vessel stroke patients is unlikely to have high diagnostic utility.
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    Nivel de independencia y su relación con la participación social en pacientes con secuelas de enfermedad cerebrovascular de Valledupar
    (Valledupar: Universidad de Santander, 2019-05-21) Gómez Guerra, Olga-Margarita; Rueda Rengifo, Nathalia; Martínez Montenegro, Loraine-Zenith
    Stroke is the accelerated progression of clinical signs of brain function, it is the most deadly and disabling of neurological diseases, it has as a main consequence a series of sequels that create a disability in the person of great importance, in addition to limitations and restrictions in most of the tasks performed by a person in their daily lives, both in their social role and their integrity, being dependent to a greater or lesser degree depending on the severity of the disease that, in addition to affecting individual integrity, as well as in the participation social of the subject. This is a research of quantitative approach, cross-sectional analytical study, the object of study is 269 people with stroke with a sample of 14 people, sociodemographic characteristics were obtained by means of a questionnaire adapted from the 2005 census survey for people with disability; a core set designed by ICF Research Branch was used to determine the performance and capacity in certain activities and / or roles of the individuals; and the Barthel index to measure the level of independence of the basic activities of daily life. It was found that there is a greater number of people with stroke in the age range of 60-69 years, the majority being female, of which 35.7% have moderate independence with restriction in the activities of getting, maintaining and finishing a job, paid and unpaid work and economic self-sufficiency. It is concluded that the independence does not influence the social participation, also that the process of physiotherapeutic evaluation regarding these two areas is not relevant when it comes to delving into them during the intervention by the professional.
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    Peripheral Blood MCEMP1 Gene Expression as a Biomarker for Stroke Prognosis
    (2016-01-12) Lopez-Jaramillo, Patricio; Raman, Kripa; O’Donnell, Martin J.; Czlonkowska, Anna; Duarte, Yan Carlos; Peñaherrera, Ernesto; Sharma, Mike; Shoamanesh, Ashkan; Skowronska, Marta; Yusuf, Salim; Paré, Guillaume
    Background and Purpose—A limitation when making early decisions on stroke management is the lack of rapid diagnostic and prognostic testing. Our study sought to identify peripheral blood RNA biomarkers associated with stroke. The secondary aims were to assess the discriminative capacity of RNA biomarkers for primary stroke type and stroke prognosis at 1-month. Methods—Whole-blood gene expression profiling was conducted on the discovery cohort: 129 first-time stroke cases that had blood sampling within 5 days of symptom onset and 170 control participants with no history of stroke. Results—Through multiple regression analysis, we determined that expression of the gene MCEMP1 had the strongest association with stroke of 11181 genes tested. MCEMP1 increased by 2.4-fold in stroke when compared with controls (95% confidence interval, 2.0–2.8; P=8.2×10−22). In addition, expression was elevated in intracerebral hemorrhage when compared with ischemic stroke cases (P=3.9×10−4). MCEMP1 was also highest soon after symptom onset and had no association with stroke risk factors. Furthermore, MCEMP1 expression independently improved discrimination of 1-month outcome. Indeed, discrimination models for disability and mortality that included MCEMP1 expression, baseline modified Rankin Scale score, and primary stroke type improved discrimination when compared with a model without MCEMP1 (disability Net Reclassification Index, 0.76; P=3.0×10−6 and mortality Net Reclassification Index, 1.3; P=1.1×10−9). Significant associations with MCEMP1 were confirmed in an independent validation cohort of 28 stroke cases and 34 controls. Conclusions—This study demonstrates that peripheral blood expression of MCEMP1 may have utility for stroke diagnosis and as a prognostic biomarker of stroke outcome at 1-month.
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    Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): An international observational study
    (2018-05) Langhorne, Peter; O'Donnell, Martin J.; Lim Chin, Siu; Zhang, Hongye; Xavier, Denis; Avezum, Alvaro; Mathur, Nandini; Turner, Melanie; MacLeod, Mary Joan; Lopez-Jaramillo, Patricio; Damasceno, Albertino; Hankey, Graeme J.; Dans, Antonio; ElSayed, Ahmed; Mondo, Charles; Wasay, Mohammad; Czlonkowska, Anna; Weimar, Christian; Hussein Yusufali, Afzal; AlHussain, Fawaz; Lisheng, Liu; Diener, Hans Christoph; Ryglewicz, Danuta; Pogosova, Nana; Iqbal, Romaina; Diaz, Rafael; Yusoff, Khalid; Oguz, Aytekin; Wang, Xingyu; Penaherrera, Ernesto; Lanas, Fernando; Ogah, Okechukwu S.; Ogunniyi, Adesola; Iversen, Helle K.; Malaga, German; Rumboldt, Zvonko; Magazi, Daliwonga; Nilanont, Yongchai; Rosengren, Annika; Oveisgharan, Shahram; Yusuf, Salim; On behalf of the INTERSTROKE collaborators
    Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes. Funding: Chest, Heart and Stroke Scotland.
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    Renal Impairment and Risk of Acute Stroke: The INTERSTROKE Study
    (Karger Publishers, 2021-05-05) Smyth, Andrew; Judge, Conor; Wang, Xingyu; Pare, Guillaume; Rangarajan, Sumathy; Canavan, Michelle; Chin, Siu Lim; Al-Hussain, F.; Yusufali, Afzalhussein; ElSayed, Ahmed; Damasceno, Albertino; Avezum, Alvaro; Czlonkowska, Anna; Rosengren, Annika; Dans, Antonio; Oguz, Aytekin; Mondo, Charles; Weimar, Christian; Ryglewicz, Danuta; Xavier, Denis; Lanas, Fernando; Malaga, German; Hankey, Graeme J.; Iversen, Helle K.; Zhang, Hongye; Yusoff, Khalid; Pogosova, Nana; Lopez-Jaramillo, Patricio; Langhorne, Peter; Diaz, Rafael; Oveisgharan, Shahram; Yusuf, Salim; O’Donnell, Martin J.; The INTERSTROKE investigators; Masira
    Background: Previous studies reported an association of renal impairment with stroke, but there are uncertainties underpinning this association. Aims: We explored if the association is explained by shared risk factors or is independent and whether there are regional or stroke subtype variations. Methods: 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 <60 mL/min/1.73 m2. Multivariable conditional logistic regression was used to determine the association of renal function with stroke. Results: 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 m2. The prevalence of renal impairment was higher in cases (22.9% vs. 17.7%, p < 0.001) and differed by region (p < 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) (pinteraction 0.12). The largest magnitudes of association were seen in younger participants and those living in Africa, South Asia, or South America (pinteraction < 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). Conclusion: Renal impairment is an important risk factor for stroke, particularly in younger patients, and is associated with more severe stroke and worse outcomes.
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    Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE). A Case-Control Study
    (Oxford Academic, 2021-04-01) Judge, Conor; O’Donnell, Martin J.; Hankey, Graeme J.; Rangarajan, Sumathy; Lim Chin, Siu; Rao-Melacini, Purnima; Ferguson, John; Smyth, Andrew; Xavier, Denis; Lisheng, Liu; Zhang, Hongye; Lopez-Jaramillo, Patricio; Damasceno, Albertino; Langhorne, Peter; Rosengren, Annika; Dans, Antonio; Elsayed, Ahmed; Avezum, Alvaro; Mondo, Charles; Ryglewicz, Danuta; Czlonkowska, Anna; Pogosova, Nana; Weimar, Christian; Diaz, Rafael; Yusoff, Khalid; Yusufali, Afzalhussein; Oguz, Aytekin; Wang, Xingyu; Lanas, Fernando; Ogah, Okechukwu S.; Ogunniyi, Adesola; Iversen, Helle K.; Malaga, German; Rumboldt, Zvonko; Oveisgharan, Shahram; Hussain, Fawaz Al; Yusuf, Salim; INTERSTROKE investigators; Masira
    BACKGROUND Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke. METHODS We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. RESULTS Compared with an estimated urinary sodium excretion of 2.8–3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65–2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26–1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93–2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50–1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8–3.5 g/day) was associated with the lowest risk of stroke. CONCLUSIONS The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake—rather than low sodium intake—combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.