ISC17 Wednesday News Tips

February 22, 2017 Categories: Scientific Conferences & Meetings, Stroke News

Tip headlines:

  • Circadian light may relieve depressive symptoms in stroke rehab patients
  • The monster within: Aged gut bacteria linked to poor outcomes after stroke
  • Recurrent stroke risk higher among older blacks than whites
  • Liver cirrhosis associated with increased stroke risk
  • “Good” cholesterol may have different chemical properties in Alzheimer’s patients
  • Bypassing emergency department for “angio-suite” reduced treatment time in stroke patients
  • Mexican Americans may get less intensive stroke rehab than non-Hispanic whites
  • Researchers find association between gum disease and ischemic stroke risk
  • BE FAST assessment tool accurately identifies stroke
  • Tai Chi may reduce stroke risk

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 8 a.m. CT/9 a.m. ET – Session A2 – Abstract 13

Circadian light may relieve depressive symptoms in stroke rehab patients

A circadian hospital lighting system reduced depressive mood symptoms among stroke patients admitted for long-term rehabilitation, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Circadian light drives the body’s natural wakefulness and sleep cycle. Blue light is the strongest determinate and modifying factor in the light spectrum, which makes it the main body clock driver. Sunlight is the main source of blue light but it also can be found in fluorescent, LED lighting and flat-screen TVs. Blue light has been shown to boost alertness, help memory and cognitive function, and elevate mood.

Stroke patients admitted for long-term rehabilitation often lack the blue light in daytime because they spend so much time indoors. They’re also often exposed to blue light at the wrong time of day, such as in the evenings, as blue light is in standard lightning and flat screen televisions.

Researchers studied 84 stroke rehabilitation patients in an acute stroke unit. Patients participated in at least two weeks of rehabilitation in either a unit with circadian lighting or in one with standard lighting. Researchers measured the patients’ depressive moods based on two scales that rate depression and found that patients in the unit with circadian light were significantly less depressed at discharge than those in the standard light unit.

Circadian lighting should be considered as part of rehabilitation unit environments, researchers said.

Anders West, M.D., Stroke Center, Rigshospitalet, Glostrup, University of Copenhagen,  Denmark.

 

Embargoed for 9:21 a.m. CT/10:21 a.m. ET – Session A7 – Abstract 46

The monster within: Aged gut bacteria linked to poor outcomes after stroke

Our intestines are filled with a vast community of gut bacteria and other microbes known as the “microbiome". The microbiome changes significantly over the course of our lifetime and may increase the severity of brain damage after a stroke, according to a preliminary study in mice presented at the American Heart Association’s International Stroke Conference 2017.

Mice that were treated with gut bacteria from older mice after stroke had impaired recovery compared to mice who received “youthful” gut bacteria from young mice. Furthermore, mice who received gut bacteria from older mice had higher levels of γδ T cells in the gut after stroke, immune cells that have been previously shown to worsen stroke severity.

A deeper understanding of the role of gut bacteria in stroke recovery may help identify new treatments for stroke patients, researchers said.

Javiera B. Bravo-Alegria, Ph.D., University of Texas Health Science Center, Houston, Texas.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP5 -- Poster WMP58

Recurrent stroke risk higher among older blacks than whites

Among ischemic (non-bleeding) stroke survivors age 65 or older, black Americans are more likely than white Americans to have recurrent strokes, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied information on 128,789 Medicare beneficiaries who had their first ischemic stroke between 1999 and 2013, and compared one-year recurrent ischemic stroke risk in older black and white Americans.

Overall, they found that 7.8 percent of whites and 11 percent of blacks had a recurrent ischemic stroke. Blacks were 24 percent to 50 percent more likely to have recurrent stroke during each time period studied. While the disparity between black and white patients for recurrent ischemic stroke remained stable for patients age 75 years and older, it increased for those age 66 to 74.

The risk for ischemic stroke recurrence among older Americans who survived an initial ischemic stroke remains higher for blacks than whites, regardless of age group, researchers said.

Karen C. Albright, D.O., M.P.H.; The University of Alabama at Birmingham, Birmingham, Alabama.

Note: Actual presentation is 6 p.m. CT/7 p.m. ET, Wednesday, Feb. 22, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP5 – Poster WMP60

(Tip contains updated information not in the abstract.)

Liver cirrhosis associated with increased stroke risk

Liver cirrhosis is associated with an increased risk of stroke, particularly hemorrhagic (bleeding) stroke, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied a sample of Medicare beneficiary claims from 2008 to 2014.

They found:

  • Among 1,618,059 people, 1.0 percent had been diagnosed with liver cirrhosis.
  • Each year, stroke occurred in 2.2 percent of those who had liver cirrhosis, versus 1.1 percent in patients who didn’t have liver cirrhosis.
  • After adjusting for other risks, researchers found that patients with liver cirrhosis had a 40 percent higher risk of suffering a stroke than those free of the disease.
  • The higher stroke risk was more pronounced for bleeding strokes — intracerebral and subarachnoid strokes — than for ischemic (clot-caused) stroke.

The findings build on recent research examining bleeding and clotting complications of liver cirrhosis outside of the gastrointestinal system, researchers said.

Neal S. Parikh, M.D., Weill Cornell Medical College, New York City, New York. 

Note: Actual presentation is 6:10 p.m. CT/7:10 p.m. ET Wednesday, Feb. 22, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session A14 – Abstract 97

“Good” cholesterol may have different chemical properties in Alzheimer’s patients

High-density lipoprotein (HDL – “good” cholesterol) in people with Alzheimer’s disease has different chemical properties than HDL in adults without the disease, and this may contribute to cognitive impairment in those with Alzheimer’s, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

HDL is the only type of lipoprotein that can cross into and out of the blood brain barrier, and adequate HDL is associated with good cognitive function. Researchers analyzed the chemical components in HDL from the blood of Alzheimer’s patients and compared them to HDL from healthy adults.

They found that compared to healthy people, Alzheimer’s patients had a 5.5 times increase of a dysfunctional HDL subfraction, as well as a decreased protein/lipid ratio.

The associated reduction in proteins needed for brain function, such as albumin, and increase in proinflammatory components could favor inflammation in the brain and contribute to cognitive impairment.

Hua-Chen Chan, Ph.D., Assistant Investigator, Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Note: Actual presentation is 4:30 p.m. CT/5:30 p.m. ET, Wednesday, Feb. 22, 2017.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session MP1 – Poster WMP3

Bypassing emergency department for “angio-suite” reduced treatment time in stroke patients

Bypassing the emergency department to transfer stroke patients directly to an angiography procedure room (angio-suite) reduced time to start an endovascular treatment, for eligible stroke patients, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Barcelona researchers reviewed the feasibility and safety of a direct-transfer angio-suite for acute stroke patients eligible for the mechanical removal of a clot blocking brain flow (endovascular treatment).

Beginning in June 2016, hospital staff transferred stroke patients admitted to the hospital within 4.5 hours of when their stroke symptoms started directly to an angio-suite, bypassing the emergency department. The patients were evaluated and treated in the suite.

Of the 16 patients transferred, one wasn’t eligible for endovascular treatment because a scan revealed the patient had an intracranial hemorrhage (bleeding), not an ischemic stroke. The other 15 underwent endovascular treatment.

Researchers found:

  • The median time from admission to procedure start was 15 minutes among direct transfer patients as compared to 65 minutes in those who did not go directly to the angio-suite.
  • Direct transfer patients had a higher rate of non-treatable occlusions, or clots, compared to patients who first went to the ED.
  • Endovascular treatment took an average 36 minutes for the direct transfer patients, versus 55 minutes for those who received standard of care.
  • Results from the procedure were similar for both groups of patients.

“In a subgroup of acute stroke patients presenting in the early (4.5-hour) window, direct transfer and triage in the angio-suite seems feasible, safe and achieves a significant reduction in hospital workflow times,” the authors wrote.

Marc Ribo, M.D., Ph.D., Stroke Unit, Hospital Vall d'Hebron, Barcelona, Spain.

Note: Actual presentation is 5:25 p.m. CT/6:25 p.m. ET, Wednesday, Feb. 22, 2017, in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P7 – Poster WP165

Mexican-Americans may get less intensive stroke rehab than non-Hispanic whites

Mexican-American stroke survivors are more likely to receive home-based rehabilitation, while non-Hispanic whites are more likely to get more intensive inpatient rehabilitation, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

As part of the Brain Attack Surveillance in Corpus Christi (BASIC), researchers followed 72 stroke survivors for three months after their strokes. Fifty were Mexican-American and 22 were non-Hispanic white. There were no ethnic differences among the patients who were discharged home without rehabilitation services.

Researchers found:

  • Among the 48 who received rehabilitation, 73 percent of non-Hispanic whites were discharged to inpatient rehabilitation, compared to 30 percent of Mexican-Americans.
  • While none of the non-Hispanic whites studied received home rehabilitation after stroke, 51 percent of Mexican-American stroke patients received at-home rehab.

This disparity may, in part, explain why Mexican-Americans have worse neurologic, functional and cognitive results after stroke than non-Hispanic whites, researchers said.

Lewis B. Morgenstern, M.D., University of Michigan, Ann Arbor, Michigan.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Wednesday, Feb. 22, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P8 – Poster WP193

Researchers find association between gum disease and ischemic stroke risk

Adults with gum, or periodontal, disease may be at greater ischemic stroke risk, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers assessed 6,711 adults, who had not had a stroke, for periodontal disease and categorized the adults according to whether they had mild, moderate or severe periodontal disease. They followed patients for 15 years for the incidence of stroke, also documenting the stroke subtype based on cause.

A total of 299 ischemic strokes occurred during the 15 years, including 47 percent that were thrombotic stroke, from a clot within the brain’s blood vessels; 26 percent that were cardioembolic, when a blood clot forms in the heart; and 20 percent that were lacunar strokes, which occurs when there is a blockage of small arteries that supply blood to the brain.

They found:

  • Participants with mild periodontal disease were 1.9 times more likely to have an ischemic stroke than those without periodontal disease. Those with moderate periodontal disease had 2.1 times higher ischemic stroke risk and adults with severe gum disease were 2.2 times more likely to suffer an ischemic stroke than those who had no periodontal disease.
  • The association between increasing levels of periodontal disease and stroke risk was most pronounced in the cardioembolic and thrombotic stroke subtypes.

The graded association between the level of gum disease and incident ischemic stroke, supports a possible causal association between gum disease and ischemic stroke, researchers said.

Souvik Sen, M.D., M.S., M.P.H., Professor and Chair of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Wednesday, Feb. 22, 2017 in Hall E.

For more research on dental care and stroke SEE ALSO Session MP19 – Poster TMP107 “Regular dental care reduces the risk for ischemic stroke: Atherosclerosis Risk in Communities (ARIC) Study, embargoed for 3 p.m. CT/4 p.m. ET, Wednesday, Feb. 22, 2017.

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

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P10 – Poster WP264

BE FAST assessment tool accurately identifies stroke

A modified version of a simple prehospital stroke assessment tool, called BE FAST, is useful for identifying patients with large vessel occlusion (or blockages of large vessels that supply blood to the brain), according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied the accuracy of the modified BE FAST, which evaluates for Balance/Coordination, Eye Deviation, Facial Weakness, Arm/Leg Weakness, Slurred Speech/Sensory Deficits, Time of Onset. They looked at 455 ischemic stroke patient charts from July 2014 to June 2015, using information about patients’ symptoms, physical findings and more to determine BE FAST scores.

The researchers found the sensitivity (rate at which the tool positively recognizes a large vessel occlusion) for the BE FAST score to be 83 percent.

The tool’s simplicity may reduce the time it takes to deliver the appropriate treatment for stroke patients, but research involving the actual use of the tool is needed to confirm these results, researchers said.

Currently, the American Stroke Association teaches the acronym F.A.S.T. as an easy way to remember the most common stroke warning signs and how to respond: Face drooping, Arm weakness, Speech difficulty, Time to call 911.

Swati Laroia Coon, D.O., University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Wednesday, Feb. 22, 2017 in Hall E.

 

Embargoed for 3 p.m. CT/4 p.m. ET – Session P16 – Poster WP416

Tai Chi may reduce stroke risk

Weekly Tai Chi exercise sessions may reduce stroke risk by lowering high blood pressure and increasing the good cholesterol, or high-density lipoprotein (HDL), according to research presented at the American Stroke Association’s International Stroke Conference 2017.

Researchers studied how Tai Chi compared to brisk walking for reducing stroke risk in 246 adults with known stroke risk factors, including high blood pressure. Participants were randomly assigned to a group that participated in two 60-minute Tai Chi sessions each week; a walking group that walked briskly for 30 minutes every day; or a control group, which was told to maintain the activities they were doing before the study.

At three months into the assigned activities, researchers found:

  • The Tai Chi group had notably greater reductions of 10.25 mm Hg in systolic (upper number) and 6.5 mm Hg in diastolic (lower number) blood pressure measurements than those in the control group.
  • The Tai Chi group also had an average 0.16 millimole (mmol/L) increase in HDL, compared to the control group.
  • There were no notable differences in blood pressure or HDL in the walking group.
  • None of the groups experienced notable changes in total cholesterol, blood sugar levels, body mass index, waist circumference or body fat percentage.

A study longer than three months is needed to monitor the effects of continuing Tai Chi and brisk walking for stroke prevention, researchers suggested.

Aileen W. Chan, Ph.D., The Chinese University of Hong Kong, Shatin, Hong Kong.

Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Wednesday, Feb. 22, 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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