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Lifetime Risks of Cardiovascular Disease 

BACKGROUND

The lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults.

METHODS

We conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. . . .

CONCLUSIONS

Differences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.)

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• Smoking, diabetes increase risk of heart attacks, strokes, death  

They're called "risk factors" for a reason - people with high blood pressure, diabetes, high cholesterol and/or a smoking habit are much more likely to have heart attacks, strokes and other manifestations of cardiovascular disease, including death.

A new study coming out in Thursday's edition of the New England Journal of Medicine analyzed health data on more than 250,000 adults to confirm that those who had any of these risk factors were in greater peril than those who didn't. The more risk factors a person had - and the more severe they were - the greater the lifetime risk of a "cardiovascular event." This trend held for both men and women, and for both whites and blacks.

The raw data in the new study came from 18 so-called cohort studies - including the Framingham Heart Study, the Multiple Risk Factor Intervention Trial, the Coronary Artery Risk Development in Young Adults study and the Multi-Ethnic Study of Artherosclerorisis - that examined people at least once when they were around the ages of 45, 55, 65 and 75.

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Your stroke risk profile may also help predict your risk of memory problems 

A new study shows a person's stroke risk profile, which includes high blood pressure, smoking, and diabetes, may also be helpful in predicting whether a person will develop memory and thinking problems later in the life. The research is published in the Nov. 8, 2011, issue of Neurology®, the medical journal of the American Academy of Neurology.

Researchers in the REGARDS study followed 23,752 people with an average age of 64 who were free of stroke and cognitive problems at the start of the study. Participants underwent a Framingham Stroke Risk Profile, which is used to determine a person's risk of stroke by measuring their age, blood pressure, education level, history of heart disease, smoking and diabetes status, and whether they have left ventricular hypertrophy (a thickening of the heart muscle) and an abnormal heart rhythm.

After an average of four years of follow-up, 1,907 people had developed memory and thinking problems.

The study found the higher a person's score on the Stroke Risk Profile, the greater the chance of developing cognitive problems four years later. Fifteen percent of people who scored among the highest 25 percent on the Stroke Risk Profile test (greater than 11.99 points) had cognitive problems compared to three percent of those who scored among the bottom 25 percent with a score below 3.4 points.

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Vascular risk factors and cognitive impairment in a stroke-free cohort 

Conclusions: Total FSRP score, elevated blood pressure, and LVH predict development of clinically significant cognitive dysfunction. Prevention and treatment of high blood pressure may be effective in preserving cognitive health.

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Your stroke risk profile may also help predict your risk of memory problems 

A new study shows a person's stroke risk profile, which includes high blood pressure, smoking, and diabetes, may also be helpful in predicting whether a person will develop memory and thinking problems later in the life. The research is published in the Nov. 8, 2011, issue of Neurology®, the medical journal of the American Academy of Neurology.

Researchers in the REGARDS study followed 23,752 people with an average age of 64 who were free of stroke and cognitive problems at the start of the study. Participants underwent a Framingham Stroke Risk Profile, which is used to determine a person's risk of stroke by measuring their age, blood pressure, education level, history of heart disease, smoking and diabetes status, and whether they have left ventricular hypertrophy (a thickening of the heart muscle) and an abnormal heart rhythm. . . .

The study found the higher a person's score on the Stroke Risk Profile, the greater the chance of developing cognitive problems four years later. Fifteen percent of people who scored among the highest 25 percent on the Stroke Risk Profile test (greater than 11.99 points) had cognitive problems compared to three percent of those who scored among the bottom 25 percent with a score below 3.4 points.

"Overall, it appears that the total Stroke Risk Profile score, while initially created to predict stroke, is also useful in determining the risk of cognitive problems," said study author Frederick Unverzagt, PhD, of Indiana University School of Medicine in Indianapolis.

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BODY AND MIND INFLUENCE QUITTING SMOKING AFTER STROKE 

DALLAS, TX — The region of the brain damaged by stroke and their intention to quit smoking before having their stroke influence patients giving up the habit, based on research reported in Stroke: Journal of the American Heart Association.

“We found that both biological and psychological factors may influence someone’s smoking status after a stroke,” said Rosa Suñer, Ph.D., lead author of the study, researcher at the Josep Trueta Hospital, Neurology Department, IdiBGi, and professor of nursing, Girona University inGirona, Spain.

One hundred and ten stroke survivors, who were smokers when they had a stroke, were studied for up to a year after being discharged from the hospital. For these patients, researchers evaluated smoking history and medical information such as type and location of stroke, functional state of the patient at discharge and their length of hospital stay. They found:

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Location of Stroke a Factor in Smoking Cessation  

Most smokers who have a stroke have not dropped the habit by one year after the event, which might be related to their intentions to quit before the stroke and the location of the stroke, researchers found.

At a single Spanish hospital, nearly 70% of smokers hospitalized for a stroke had stopped smoking by discharge, although only 40% remained abstinent at one year, according to Rosa Suñer Soler, PhD, of Girona University in Spain, and colleagues.

Those who had plans to quit smoking in the near future before the stroke were significantly more likely to have quit by one year after discharge (OR 7.29, 95% CI 1.89 to 28.07), the researchers reported online in Stroke: Journal of the American Heart Association.

Action Points

Explain that a small Spanish study found that smokers admitted to hospital for an acute stroke were more likely to have successfully quit smoking at one year if they had a preadmission intention to stop smoking in the near future or if they had a stroke affecting the insular cortex.

Note that only about one-third of patients associated smoking with an increased risk of stroke.

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• Stroke Damage to Insular Cortex Boosts Smoking Cessation 

Smokers who suffer a stroke that causes a lesion at the insular cortex are more than 5 times more likely to stop their nicotine habit than those whose stroke did not result in such a lesion, according to a new study.

In addition, the researchers found that preparedness to change also influenced successful smoking cessation poststroke.

The study results were not surprising, given that research has already shown that biological and psychological factors help explain smoking cessation in patients with stroke, said the study's lead author, Rosa Suňer Soler, PhD, from the Neurology Department, Josep Trueta Hospital, Girona, Spain.

Biologically, the insular cortex may play an important role in emotional decision-making, and in terms of psychology, smoking behavior may be explained by stages, processes, and levels of change, Dr. Suňer told Medscape Medical News. "Before you stop smoking, you must be aware that you have a problem and take the decision to stop smoking."

The study was published online November 3 in Stroke.

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Smoking Cessation 1 Year Poststroke and Damage to the Insular Cortex 

Conclusions—Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop.

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U.S. Health Officials Urge Lifestyle Changes to Cut Stroke Risk 

Americans need to take action to reduce their risk of stroke, U.S. health officials said Thursday.

Someone in the world dies of a stroke every six seconds and about 137,000 Americans die of stroke every year. That number is about equivalent to the population of Eugene, Ore. or Savannah, Ga., according to the U.S. Centers for Disease Control and Prevention.

The agency's message about stroke prevention comes ahead of World Stroke Day on Oct. 29.

A new U.S. government program, called Million Hearts, seeks to prevent 1 million strokes and heart attacks over the next five years. The program encourages people to learn and follow their ABCs: aspirin for people at risk; blood pressure control; cholesterol management; and smoking cessation.

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• Some Smokers More Likely to Quit After Stroke Than Others 

Smokers are more likely to kick the habit after a stroke if the area of their brain that processes emotions was damaged by the stroke, researchers say.

The study also found that people who planned to stop smoking before they had a stroke were much more likely to be successful at quitting than those who hadn't thought about quitting.

These findings may lead to new ways to personalize smoking cessation treatment and education programs, according to the study published Nov. 3 in the journal Stroke.

"We found that both biological and psychological factors may influence someone's smoking status after a stroke," lead author Rosa Suner, a researcher at the Josep Trueta Hospital and professor of nursing at Girona University in Spain, said in a journal news release.

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Hospital team significantly reduced risk of further vascular events after 'mini strokes' 

Patients who had a transient ischaemic attack (TIA), sometimes referred to as a "mini stroke", were much less likely to experience further vascular events in the first year if their care was co-ordinated by a special hospital team. That is the key finding from a study published in the November issue of the European Journal of Neurology.

Researchers from the Department of Neurology at Aarhus University Hospital in Denmark studied 306 patients admitted to the hospital with a TIA. They found that when the patients were treated by an acute TIA team their cumulated risk of having a stroke in the first seven days was 65% lower than expected. The cumulated risk in the first 90 days fell by 74%.

"The aim of our study was to see if patients had better clinical outcomes if they were under the care of a special team, which integrated outpatient care and stroke unit facilities and provided on-going nurse-led counselling" says lead author Dr Paul von Weitzel-Mudersbach. . . .

* The majority of the patients (95%) fulfilled at least one secondary prevention measure: reduced blood pressure, reduced cholesterol, no smoking and self-reported adherence to antithrombotic treatment. 48% achieved three out of the four targets. . . .

* More than 60% of the patients who smoked at the time of their TIA changed their smoking habits - 31% quit and 29.5% reduced their smoking by at least 50%. Most of the changes happened in the first seven days.

"Our study shows that urgent treatment of patients with TIA is feasible and associated with a substantial reduction in stroke risk during the first three months, which is consistent with previous studies from the UK and France" says Dr von Weitzel-Mudersbach.

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Announcements: World Stroke Day --- October 29, 2011 

October 29 is World Stroke Day 2011. Stroke is one of the leading causes of disability. Approximately 795,000 strokes occur annually in the United States. Stroke occurs among all age groups, including newborns, children, young adults, and older adults (1). One in six persons worldwide will have a stroke in his or her lifetime, and every 6 seconds someone will die from a stroke (2,3).

Although a common occurrence, strokes are preventable. The following actions can reduce the likelihood of having a stroke: 1) know your personal risk factors (i.e., high blood pressure, diabetes, high blood cholesterol, atrial fibrillation, or a history of transient ischemic attack or previous stroke); 2) engage in physical activity regularly; 3) avoid obesity by keeping to a healthy diet; 4) limit alcohol consumption; 5) avoid cigarette smoke and, if you smoke, seek help to stop now; 6) learn to recognize the warning signs* of a stroke, and call 9-1-1 right away if someone appears to be having a stroke. With timely care and support, most stroke survivors can recover and regain their quality of life.

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Stroke rate 25 percent higher for Metis 

The stroke rate among Manitoba Metis is nearly 25 percent higher than for other Manitobans, according to a study by the University of Manitoba and the Manitoba Metis Federation (MMF) presented today at the Canadian Stroke Congress.

The higher stroke rate is driven by a 53 percent higher smoking rate, 34 percent higher rate of diabetes, and 13 percent higher rate of high blood pressure among Metis aged 40 years and older, compared to all other Manitobans. High blood pressure, smoking and diabetes are leading risk factors for stroke.

"Being historically of both First Nation and European ancestries, but not really identifying as either one, Metis are a very unique people, but little research has been done on this population," says Dr. Judith Bartlett of the University of Manitoba and the MMF. "It's really difficult for a health system to put in place Metis-specific programs if they don't understand what that means. Our job through this study is to link the health authorities with the Metis to bridge that knowledge gap."

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Smokers May Get Strokes 10 Years Before Nonsmokers 

Now research shows that smokers tend to have strokes close to one full decade earlier than nonsmokers.

Smokers were age 58, on average, when they had a stroke, while nonsmokers were 67, on average, according to a study presented at the Canadian Stroke Congress in Ottawa.

A stroke or brain attack occurs when blood flow to the brain is blocked by a blood clot (ischemic stroke) or when a blood vessel ruptures (hemorrhagic stroke).

Smokers in the study were two times more likely to have an ischemic stroke and two to four times more likely to have a hemorrhagic stroke compared to nonsmokers.

"We have always known that the more you smoke, the more you stroke, and now we know that the more you smoke, the younger you stroke," says study researcher Andrew Pipe, MD. He's chief of the division of prevention and rehabilitation at the University of Ottawa Heart Institute and a professor in the faculty of medicine at the University of Ottawa.

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