ISC17 THURSDAY NEWS TIPS

February 23, 2017 Categories: Stroke News, Scientific Conferences & Meetings

Tip Headlines:

  • Epilepsy in the elderly linked to increased stroke risk
  • E-cigarettes may pose the same or higher risk of stroke severity as tobacco smoke
  • Biological, not chronological age, better predictor of stroke recovery
  • Parkinson’s disease may have link to stroke
  • Inadequate access to affordable, nutritious food may increase stroke risk factors
  • Symptoms of depression in stroke survivors may predict caregiver depression
  • Men more likely than women to get “ultrafast” stroke treatment
  • Military single-payer health system free of stroke care racial disparity, but rank matters
  • Children more vulnerable to psychological problems after a stroke

Note: All Times are Central (CT). All tips are embargoed until the time of presentation or 3 p.m. CT/4 p.m. ET each day, whichever comes first.

Embargoed for 9:57 a.m. CT/10:57 a.m. ET – Session A20 – Abstract 140

Epilepsy in the elderly linked to increased ischemic stroke risk

Elderly patients with seizures have an increased risk of future stroke, but not heart attack, when compared to those without seizures, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers analyzed inpatient and outpatient claims data on 1,548,556 Medicare beneficiaries ages 66 and older. One percent (15,055 people) developed epilepsy and nearly 8 percent (121,866 people) had an ischemic (clot-caused) stroke or heart attack during an average follow-up of 4.4 years.

Researchers found:

  • After statistically adjusting for established stroke and heart attack risk factors, epilepsy was associated with a 77 percent increased risk of stroke.
  • On average, patients with seizures were older and were more likely to have other types of vascular disease.
  • Epilepsy was not independently associated with an increased risk of heart attack.

The study suggests that epilepsy in the elderly might signify disease of blood vessels in the brain, but not necessarily diseased vessels elsewhere in the body, researchers said.

Matthew Mercuri, M.D., Weill Cornell Medicine, New York City, New York.

 

Embargoed for 1:42 p.m. CT/2:42 p.m. ET – Session A25 – Abstract LB10 in Grand Ballroom B

E- cigarettes may pose the same or higher risk of stroke severity as tobacco smoke

 NOTE - On Feb. 24 - the e-cigarette tip was updated to correct the third bullet point, per researcher.

Electronic cigarette (e-cigarettes) vaping may pose just as much or even higher risk as smoking tobacco for worsening a stroke, according to a preliminary study in mice presented at the American Heart Association’s International Stroke Conference 2017.

Researchers found:

  • Mice exposed to e-cigarette vapor for 10 days or 30 days had worse stroke outcome and neurological deficits, than those exposed to tobacco smoke.
  • E-cigarette exposure decreased glucose uptake in the brain. Glucose fuels brain activity.
  • Both e-Cig and tobacco smoke exposure for 30 days decreased Thrombomodulin (anti-coagulant) levels. 

From a brain health perspective, researchers said, electronic-cigarette vaping is not safer than tobacco smoking, and may pose a similar, if not higher risk for stroke severity.

Use of e-cigarettes is a growing health concern in both smoking and nonsmoking populations. Researchers said rigorous studies are needed to investigate the effects of the nicotine exposure via e-cigarettes on brain and stroke outcome.

Ali Ehsan Sifat, Graduate Student/Research Assistant, Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, Texas.

 

Embargoed for 2:30 p.m. CT/3:30 p.m. ET – Session A23 – Abstract 160

Biological, not chronological age, better predictor of stroke recovery

Biological age and not chronological age may help predict a patient’s recovery three months after a stroke, according to a preliminary study presented at the American Heart Association’s International Stroke Conference 2017.

Age is considered an important predictor of the severity of a stroke, but the chronological number is not the only way to measure age.

Researchers analyzed 600 adults with ischemic stroke (clot-caused stroke) who were assessed in Hospital del Mar in Barcelona. Biological age was estimated by analyzing a particular characteristic in DNA molecules that change over time (degree of methylation at 71 specific sites throughout the genome of the individual).

Researchers found DNA structure changes as a person gets older, so the extent of change can be used as an estimate of biological age. Other indicators that may also predict a patient’s recovery are neurological status at admission, degree of changes in mobility after stroke, and promptness of the restoration of blood flow in the brain.

The findings suggest biological age is an important factor in a patient’s recovery after stroke and better stroke recovery is another benefit of healthy aging, researchers said.

Jordi Jimenez-Conde, M.D., Ph.D., Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.

 

Embargoed for 3 p.m. CT/4 p.m. ET –  Session P25 – Poster TP165

Parkinson’s disease may have link to stroke

Parkinson’s disease may be linked to stroke, much like Alzheimer’s disease and stroke are linked, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

To see if an association exists between stroke and Parkinson’s disease, a common neurodegenerative condition, researchers studied medical claims information from 2008 to 2014 in a sample of Medicare beneficiaries, aged 66 years and older. In separate analyses, they also studied the relationship between stroke and Alzheimer’s disease for comparison.

In their analysis of 1.6 million patients, researchers found:

  • The annual incidence of ischemic (clot caused) stroke was 1.75 percent among those diagnosed with Parkinson’s compared to 0.96 percent in those without Parkinson’s.
  • In contrast, the annual incidence of ischemic stroke was 1.96 percent among those diagnosed with Alzheimer’s disease, versus 0.96 percent in those without Alzheimer’s.
  • The annual incidence of Parkinson’s disease was 0.97 percent after ischemic stroke versus 0.39 percent in those without ischemic stroke.
  • In contrast, the annual incidence of Alzheimer’s was 3.66 percent in elderly adults diagnosed with stroke, versus 1.17 percent in those without ischemic stroke.

Among Medicare beneficiaries, the relationships between stroke and Parkinson’s disease were similar to those between stroke and Alzheimer’s disease, researcher said.

Benjamin R. Kummer, M.D., Weill Cornell Medical College, New York, N.Y.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P25 – Poster TP183

Inadequate access to affordable, nutritious food may increase stroke risk factors

Food insecurity – the state of being without reliable access to adequate amounts of affordable, nutritious food – is a common issue and may lead to increased stroke risk factors, such as diabetes and high blood pressure, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers at a Chicago hospital that serves uninsured and underinsured patients studied 216 patients in the outpatient neurology clinic. Using a standardized two-question screening tool and reviewing electronic medical records, researchers identified 49 patients, or 22.7 percent, as food insecure.

Researchers also found:

  • Of the 64 patients diagnosed with stroke, 18.8 percent were found to be food insecure.
  • In the food insecure stroke group, 84.6 percent also had hypertension; 58.3 percent diabetes; and 16.7 percent had a previous stroke.
  • Among stroke survivors not labelled food insecure, 67.3 percent had hypertension; 28.8 percent had diabetes; and 21.2 percent had a previous stroke.

Food insecurity may lead to an increase in stroke risk factors and can complicate management of these health problems. A better understanding of the magnitude of the problem is necessary and could lead to interventions, researchers said.

Lakshmi Warrior, M.D., John H. Stroger Hospital of Cook County, Chicago, Illinois may be reached through Alexandra Normington, Director of Media at Cook County Health & Hospitals System.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP14 – Poster TMP49

Symptoms of depression in stroke survivors may predict caregiver depression

Stroke survivors’ depressive symptoms predict caregivers’ depressive symptoms, but caregivers’ well-being does not predict stroke survivors’ depression or quality of life, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied interviews of 248 stroke survivors and their primary caregivers at 9-, 18-, 27- and 36-months after the survivors’ strokes.

They found:

  • Seventeen percent of stroke survivors and 13.7 percent of caregivers had clinically significant levels of depressive symptoms at nine months.
  • The measurements revealed that high stroke survivor depressive symptoms at nine-months post-stroke predicted increases in caregiver depressive symptoms at 18-months post-stroke.
  • There were no predictive effects, over time, for caregivers’ depressive symptoms on stroke survivors’ depression or health-related quality of life.

Treating elevated depressive symptoms in stroke survivors may also improve caregiver well-being, researchers said.

David L. Roth, Ph.D., Johns Hopkins University, Baltimore, Maryland.

Note: Actual presentation is 6:10 p.m. CT/7:10 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP18 – Poster TMP88

Men more likely than women to get “ultrafast” stroke treatment

Male stroke patients are twice as likely as female patients to get clot-busting stroke treatment less than 30 minutes after hospital arrival, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

The benefits of treating acute ischemic (clot-caused) stroke patients with intravenous tissue-type plasminogen activator (tPA) are time dependent. AHA/ASA guidelines recommend that acute ischemic stroke patients get the clot-busting treatment within 60 minutes of hospital arrival, which is called door-to-needle time. Still, researchers suggest that with every 15-minute reduction in treatment time, patients’ health results improve by an estimated 4 percent.

In this study, researchers identified characteristics of patients with treatment times of less than 30 minutes, called ultrafast door-to-needle times. They studied stroke patient information from a 26-hospital health system and found:

  • from 2009 to 2015, 2,695 acute ischemic stroke patients received tPA;
  • of those, 3.9 percent, had ultrafast door-to-needle times; and
  • ultrafast door-to-needle time patients were more than twice as likely to be male, more than four-times as likely to arrive by ambulance, and nearly twice as likely to arrive on a weekday.

The study suggests that only a small percentage of these stroke patients receive ultrafast treatment and highlights the need to better understand the role gender plays in treatment-related decisions, researchers said.

Archit Bhatt, M.D., M.P.H., Providence Brain and Spine Institute, Portland, Oregan.

Note: Actual presentation is 5:25 p.m. CT/6:25 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP17 – Poster TMP79

Military single-payer health system free of stroke care racial disparity, but rank matters

Racial disparity in the care of stroke patients, which exists in the civilian U.S. healthcare system, does not appear to exist in the U.S. military healthcare system, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

However, they noted better outcomes after stroke for those in higher ranks versus lower ranks.

Researchers studied stroke outcomes, or results, among stroke survivors in the single-payer U.S. military healthcare system, in which every member has the same health benefits. They collected information from 2010 to 2015 on 3,623 patients admitted to military care facilities and discharged with the diagnosis of stroke. They studied race and rank.

They found no correlation between race and total cost of hospitalization or outcome. However, they did find a “statistically significant trend” toward better outcomes after stroke for those in higher ranks versus lower ranks.

Matthew Holtkamp, D.O., Carl R. Darnell Army Medical Center, Harker Heights, Texas.

Note: Actual presentation is 5:40 p.m. CT/6:40 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P33 – Poster TP405

Children more vulnerable to psychological problems after a stroke

Children who have suffered ischemic (clot-caused) strokes are more likely to have psychological problems, including anxiety and behavioral difficulties, than children who have not had a stroke, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied 50 children who had suffered an ischemic stroke at a range of ages – from one month to about 17 years. Parents completed a behavioral checklist at least 10 months after their child’s stroke.

Researchers found:

  • Children with stroke had notably greater mood, anxiety, somatic (physical), oppositional defiance and conduct problems than children without stroke.
  • Children who had strokes at ages younger than six years had notably higher anxiety levels than older children who had stroke. That could be due to changes in family dynamics when young children suffer a neurological injury, researchers said.

“These results support the need for careful psychological follow-up in this vulnerable population,” researchers said.

Emily Maxwell, Ph.D., University of Colorado School of Medicine, Aurora, Colorado.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Thursday, Feb. 23, 2017 in Hall E.

Additional Resources:

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Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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AHA/ASA News Media in Dallas: (214) 706-1173

AHA/ASA News Media Office, Feb. 21-24,

at the George R. Brown Convention Center: (713) 853-8406

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heart.org and strokeassociation.org

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