Thursday, February 02, 2023

Novel celery seed-derived medicine given after clot treatment may improve stroke outcomes

American Stroke Association International Stroke Conference 2023, Abstract 90

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • Ninety days after a clot-caused stroke, people who received a celery seed-derived medication in addition to prompt treatment for the clot had less severe neurological symptoms and better functioning in comparison to those who received clot treatment and a placebo medication.
  • The celery seed-derived medication, called butylphthalide, may help protect brain tissue from damage when the supply of oxygenated blood is cut off.
  • Butylphthalide is approved and available for use in China, where the study was conducted; however, it has not been approved for use in the United States.


DALLAS, Feb. 2, 2023 — People who had an ischemic (clot-caused) stroke and were treated with a clot-busting medication and/or mechanical clot removal and also received butylphthalide, a medication initially compounded from celery seed, experienced milder neurological symptoms with better functioning at three months after the stroke, compared to stroke patients who had their clots treated but received a placebo medication, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference  2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

In previous studies in China, butylphthalide has shown the potential to safely protect and preserve the brain from possible damage related to stroke in animal models with a clot-caused stroke. The current study evaluated whether treatment with butylphthalide may improve the outcomes of people who initially received the intravenous clot-busting medication tissue plasminogen activator (tPA) and/or a mechanical clot removal procedure to physically remove the clot plus butylphthalide. In China, butylphthalide is licensed for use in treating ischemic stroke; however, it is not currently approved by the U. S. Food and Drug Administration.

“This is the first trial to show the benefit of using a medication that protects the brain from damage caused by a lack of oxygen to brain tissue. The medication was given to patients with acute ischemic stroke who were also receiving treatment to restore blood flow to the brain,” said Baixue Jia, M.D., co-author of the study, an attending physician in interventional neuroradiology in the department of neurology in the Beijing Tiantan Hospital of Capital Medical University and a faculty member at the China National Clinical Research Center for Neurological Diseases, both in Beijing.

The researchers studied 90-day outcomes in 1,216 adults (average age of 66 years; 68% men) after they suffered a stroke that was initially treated with tPA or mechanical clot removal therapy. The participants were treated between 2018 and 2022 at one of 59 medical centers in China. People who had minimal stroke symptoms on their initial exam (defined as 0-3 on the National Institutes of Health Stroke Scale, or NIHSS) or had severe stroke symptoms (defined as >26 on the NIHSS) were excluded from this study.

Along with their physician-chosen initial treatment, participants were randomly selected to receive either butylphthalide or a look-alike placebo administered by daily intravenous injection for the first 14 days, followed by 76 days of oral capsules. The patients were randomly assigned to the butylphthalide treatment group (607 adults) or the placebo group (609 adults). Neither the patients nor the research team knew which participants were assigned to which treatment.

Outcomes were deemed favorable if an individual had the following markers at 90-days post-stroke:

  • an initially mild to moderate stroke (4-7 on the NIHSS) and had no symptoms (0 on the modified Rankin Scale, a scale that measures disability and dependence) after treatment;
  • an initially moderate to serious stroke (8-14 on the NIHSS) and had no residual symptoms or mild symptoms that did not impair their ability to perform routine activities of daily living without assistance (0-1 on the disability scale); or
  • an initially serious to severe stroke (15-25 on the NIHSS) had no remaining symptoms or a slight disability that impaired some activities yet still allowed a person to conduct their own affairs without assistance (0-2 on the disability scale).

The study found:

  • Participants in the butylphthalide group were 70% more likely to have a favorable 90-day outcome compared to the placebo group.
  • Butylphthalide improved function equally well in the subsets of patients who initially received tPA, those who received endovascular therapy or those who received both tPA and endovascular treatment.
  • Secondary events, such as recurrent stroke and intracranial hemorrhage (brain bleeds), were not significantly different between the butylphthalide and placebo groups.

“Patients who received butylphthalide had less severe neurological symptoms and a better living status at 90-days post-stroke compared to those who received the placebo. If the results are confirmed in other trials, this may lead to more options to treat strokes caused by clots,” Jia said.

How butylphthalide works isn’t clear, with animal studies suggesting various possible mechanisms. “The next step should be investigating the exact mechanisms of butylphthalide in humans,” Jia said.

The study is limited by being based on participants who all received initial treatment with clot-busting intravenous medication or a procedure to remove the clot or both, so the results may not be generalizable to stroke patients who received other treatments. Results from this trial conducted in China may not be generalizable to other populations. In addition, butylphthalide is not approved by the FDA for any use in the U.S.

“While these are interesting results, this is only one relatively small study on a fairly select population in China. Butylphthalide, a medication initially compounded from celery seed, is not ready for use in standard stroke treatment; however, these results warrant further study consideration,” said American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor and director, in the Division of Translational Neurosciences and Population Studies and the department of neurology at the Medical University of South Carolina in Charleston, South Carolina. “The medication used in this study is not the same as celery seed or celery seed extract supplements. Stroke survivors should always consult with their neurologist or health care professional regarding diet after a stroke.” Dr. Lackland was not involved in this study.

Co-authors are lead author Anxin Wang, Ph.D.; Xuelei Zhang, M.D.; Yilong Wang Sr., M.D., Ph.D.; and Zhongrong Miao, M.D., Ph.D. Authors’ disclosures are listed in the abstract.

The study was funded by the National Key Technology Research and Development Program of the Ministry of Science and Technology of the People’s Republic of China and Shijiazhuang Pharmaceutical Group dl-3-butylphtahalide Pharmaceutical.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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Smartphone app may help identify stroke symptoms as they occur


American Stroke Association International Stroke Conference 2023, Abstract WMP120

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • A new smartphone application called FAST.AI may recognize common stroke symptoms as they are happening.
  • Preliminary research suggests the app might be as accurate at diagnosing stroke as a neurologist.
  • Early recognition of stroke symptoms may result in more timely treatment, which may minimize the long-term effects of a stroke and improve chances for a full recovery.


DALLAS, Feb. 2, 2023 — A new smartphone application called FAST.AI may help people who are having a stroke or their family and caregivers recognize common stroke symptoms in real time, prompting them to quickly call 9-1-1, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Heart Association, stroke is the No. 5 cause of death and a leading cause of disability in the U.S. About 85% of all strokes in the U.S. are ischemic strokes, which are caused by a blood clot in a blood vessel that blocks the flow of blood to the brain.

FAST.AI is a fully automated smartphone application for detection of severe stroke using machine learning algorithms to recognize facial asymmetry (drooping of the muscles in the face), arm weakness and speech changes – all common stroke symptoms. This study is ongoing, and the mobile application is still in development and not available to the public.

The smartphone application uses a facial video of the patient to examine 68 facial landmark points; sensors that measure arm movement and orientation; and voice recordings detect speech changes. Information from each test was sent to a database server for analysis.

Researchers validated FAST.AI’s performance by testing nearly 270 patients with a diagnosis of acute stroke (41% women; average age of 71 years) within 72 hours of hospital admission at four major metropolitan stroke centers in Bulgaria (St. Anna University Hospital in Sofia; University Hospital Haskovo in Haskovo; University Hospital Pulmed in Plovdiv; and University Hospital “Prof. Dr. Stoyan Kirkovich” in Stara Zagora) from July 2021 to July 2022. Neurologists who examined the patients tested the app then compared the FAST.AI results with their clinical impressions.

The analysis found:

  • The smart phone app accurately detected stroke-associated facial asymmetry in nearly 100% of patients.
  • The app accurately detected arm weakness in more than two-thirds of the cases.
  • And while the slurred speech module remains to be fully validated and tested, preliminary analyses confirmed that it may be able to reliably detect slurred speech, according to the researchers.

Clot-busting medication should be administered within three hours (up to four-and-a-half hours in certain eligible patients) after symptoms begin. And the faster the treatment is administered, the more likely for a better recovery: on average, 1.9 million brain cells die every minute that a stroke goes untreated, according to the American Stroke Association, a division of the American Heart Association. Previous research has found that stroke patients who are treated within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability in comparison to those who received treatment more than 90 minutes after symptoms begin.

“Many stroke patients don’t make it to the hospital in time for clot-busting treatment, which is one reason why it is vital to recognize stroke symptoms and call 9-1-1 right away,” said study author Radoslav I. Raychev, M.D., FAHA, a clinical professor of neurology and a vascular neurologist at the University of California, Los Angeles. “These early results confirm the app reliably identified acute stroke symptoms as accurately as a neurologist, and they will help to improve the app’s accuracy in detecting signs and symptoms of stroke.”

A limitation of the study is that neurologists (not the individuals, family members or caregivers) conducted the screenings and taught patients how to use the application.

American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston, South Carolina, applauded the research as a promising tool to address a major health challenge – how to prompt individuals with stroke symptoms to seek care in a short window of opportunity.

“This abstract describes a validated approach for an easy assessment of signs of a stroke and the prompt to seek care. The app may help individuals assess the signs of a stroke without the need to recall the warning signs, ” said Lackland, who was not involved in the study.

Co-authors are Jeffrey L. Saver, M.D., FAHA; David S. Liebeskind, M.D., FAHA; Svetlin Penkov, Ph.D.; Daniel Angelov, Ph.D.; Krasimir Stoev; Todor Todorov; Teodora Sakelarova, M.D.; Dobrinka Kalpachka, M.D.; Hristiana Pelyova, M.D.; Rostislava Ruseva, M.D.; Svetlana Velcheva, M.D.; Emanuela Kostadinova, M.D.; Denislav Dimov, M.D.; Kolarova Anna, M.D.; Teodora Manolova, M.D.; Filip Alexiev, M.D., Ph.D.; and Ivan Milanov, M.D., Ph.D.  Authors’ disclosures are listed in the abstract.

The app is owned by Neuronics Medical, of which Raychev is a co-founder. Boehringer Ingelheim funded the study through a research grant with no app ownership. The Bulgarian Society of Neurology helped with study organization. Study senior author, Ivan Milanov is president of the Bulgarian Society of Neurology.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


IT HAPPENED TO ME

Stroke symptoms, even if they disappear within an hour, need emergency assessment


A new American Heart Association scientific statement discusses rapid evaluation for transient ischemic attack (TIA) due to high risk of future stroke

Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

Statement Highlights:

  • Diagnosing a transient ischemic attack (TIA), sometimes called a “warning stroke,” is challenging because symptoms often disappear within an hour.
  • A new American Heart Association scientific statement describes how to assess patients who experience a TIA, with specific guidance for health care professionals in rural areas.
  • Nearly one in five people who have a suspected TIA will have a full-blown stroke within three months, and two in five, given the appropriate scan, will learn they have actually had a stroke instead of a TIA.
  • Comprehensive evaluation of suspected TIA patients with imaging and use of risk assessment scoring may help determine which patients should be hospitalized because they are at the highest risk for a full-blown stroke.

DALLAS, January. 19, 2023 — Stroke symptoms that disappear in under an hour, known as a transient ischemic attack (TIA), need emergency assessment to help prevent a full-blown stroke, according to a new American Heart Association scientific statement published today in the Association’s journal Stroke. The statement offers a standardized approach to evaluating people with suspected TIA, with guidance specifically for hospitals in rural areas that may not have access to advanced imaging or an on-site neurologist.

TIA is a temporary blockage of blood flow to the brain. Each year, about 240,000 people in the U.S. experience a TIA, although this estimate may represent underreporting of TIA because symptoms tend to go away within an hour. While the TIA itself doesn’t cause permanent damage, nearly 1 in 5 of those who have a TIA will have a full-blown stroke within three months after the TIA, almost half of which will happen within two days. For this reason, a TIA is more accurately described as a warning stroke rather than a “mini-stroke,” as it’s often called.

TIA symptoms are the same as stroke symptoms, only temporary. They begin suddenly and may have any or all of these characteristics:

  • Symptoms begin strong then fade;
  • Symptoms typically last less than an hour;
  • Facial droop;
  • Weakness on one side of the body;
  • Numbness on one side of the body;
  • Trouble finding the right words/slurred speech; or
  • Dizziness, vision loss or trouble walking.

The F.A.S.T. acronym for stroke symptoms can be used to identify a TIA: F ― Face drooping or numbness; A ― Arm weakness; S ― Speech difficulty; T ― Time to call 9-1-1, even if the symptoms go away.

“Confidently diagnosing a TIA is difficult since most patients are back to normal function by the time they arrive at the emergency room,” said Hardik P. Amin, M.D., chair of the scientific statement writing committee and associate professor of neurology and medical stroke director at Yale New Haven Hospital, St. Raphael Campus in New Haven, Connecticut. “There also is variability across the country in the workup that TIA patients may receive. This may be due to geographic factors, limited resources at health care centers or varying levels of comfort and experience among medical professionals.”

For example, Amin said, “Someone with a TIA who goes to an emergency room with limited resources may not get the same evaluation that they would at a certified stroke center. This statement was written with those emergency room physicians or internists in mind – professionals in resource-limited areas who may not have immediate access to a vascular neurologist and must make challenging evaluation and treatment decisions.”

The statement also includes guidance to help health care professionals tell the difference between a TIA and a “TIA mimic” – a condition that shares some signs with TIA but is due to other medical conditions such as low blood sugar, a seizure or a migraine. Symptoms of a TIA mimic tend to spread to other parts of the body and build in intensity over time.

Who is at risk for a TIA?

People with cardiovascular risk factors, such as high blood pressure, diabetes, obesity, high cholesterol and smoking, are at high risk for stroke and TIA. Other conditions that increase risk of a TIA include peripheral artery disease, atrial fibrillation, obstructive sleep apnea and coronary artery disease. In addition, a person who has had a prior stroke is at high risk for TIA.

Which tests come first once in the emergency room?

After assessing for symptoms and medical history, imaging of the blood vessels in the head and neck is an important first assessment. A non-contrast head CT should be done initially in the emergency department to rule out intracerebral hemorrhage and TIA mimics. CT angiography may be done as well to look for signs of narrowing in the arteries leading to the brain. Nearly half of people with TIA symptoms have narrowing of the large arteries that lead to the brain.

A magnetic resonance imaging (MRI) scan is the preferred way to rule out brain injury (i.e., a stroke), ideally done within 24 hours of when symptoms began. About 40% of patients presenting in the ER with TIA symptoms will actually be diagnosed with a  stroke based on MRI results. Some emergency rooms may not have access to an MRI scanner, and they may admit the patient to the hospital for MRI or transfer them to a center with rapid access to one.

Blood work should be completed in the emergency department to rule out other conditions that may cause TIA-like symptoms, such as low blood sugar or infection, and to check for cardiovascular risk factors like diabetes and high cholesterol.

Once TIA is diagnosed, a cardiac work-up is advised due to the potential for heart-related factors to cause a TIA. Ideally, this assessment is done in the emergency department, however, it could be coordinated as a follow-up visit with the appropriate specialist, preferably within a week of having a TIA. An electrocardiogram to assess heart rhythm is suggested to screen for atrial fibrillation, which is detected in up to 7% of people with a stroke or TIA. The American Heart Association recommends that long-term heart monitoring within six months of a TIA is reasonable if the initial evaluation suggests a heart rhythm-related issue as the cause of a TIA or stroke.

Early neurology consultation, either in-person or via telemedicine, is associated with lower death rates after a TIA. If consultation isn’t possible during the emergency visit, the statement suggests following up with a neurologist ideally within 48 hours but not longer than one week after a TIA, given the high risk of stroke in the days after a TIA. The statement cites research that about 43% of people who had an ischemic stroke (caused by a blood clot) had a TIA within the week before their stroke.

Assessing stroke risk after TIA

A rapid way to assess a patient’s risk of future stroke after TIA is the 7-point ABCD2 score, which stratifies patients into low, medium and high risk based on Age, Blood pressure, Clinical features (symptoms), Duration of symptoms (less than or greater than 60 minutes) and Diabetes. A score of 0-3 indicates low risk, 4-5 is moderate risk and 6-7 is high risk. Patients with moderate to high ABCD2 scores may be considered for hospitalization.

Collaboration among emergency room professionals, neurologists and primary care professionals is critical to ensure the patient receives a comprehensive evaluation and a well-communicated outpatient plan for future stroke prevention at discharge.

“Incorporating these steps for people with suspected TIA may help identify which patients would benefit from hospital admission, versus those who might be safely discharged from the emergency room with close follow-up,” Amin said. “This guidance empowers physicians at both rural and urban academic settings with information to help reduce the risk of future stroke.”

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Emergency Neurovascular Care Committee of the Stroke Council and the Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists, and it is endorsed by the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS).

American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Tracy E. Madsen, M.D., Ph.D.; Dawn M. Bravata, M.D.; Charles R. Wira, M.D.; S. Claiborne Johnston, M.D., Ph.D.; Susan Ashcraft, D.N.P.; Tamika Marquitta Burrus, M.D.; Peter David Panagos, M.D.; Max Wintermark, M.D., M.A.S.; and Charles Esenwa, M.D., M.S.

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 biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

Additional Resources:

JOURNAL

Stroke

DOI

10.1161/STR.0000000000000418 

ARTICLE TITLE

Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association

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MISOGYNISTIC MEDICINE

Dual blood thinners under prescribed after minor or warning stroke, especially in women


American Stroke Association International Stroke Conference 2023, Abstract 43

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.
  • In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.
  • Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.

“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, M.D., lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.

To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.

The analysis found:

  • DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
  • Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
  • The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.

“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Solomonow said.

The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.

“The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed  statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anti-coagulation for atrial fibrillation.”

The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.

“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.

Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.

The study was funded by the department of neurology at the University of Maryland.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Recurrent stroke risk decreasing, with twice the decline among women vs. men in South Texas


American Stroke Association International Stroke Conference 2023, Abstract 82

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women vs. men, according to a study conducted in South Texas.

  • Researchers suggest more study is needed to understand the reasons behind the welcome decline in trends in stroke recurrence for both sexes, as well as the reasons for the changes in sex differences over time.

Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Feb. 2, 2023

DALLAS, Feb. 2, 2023 — The risk of recurrent stroke has declined in the past 20 years among all stroke survivors, with twice the decline among women compared to men, according to preliminary research conducted in South Texas that will be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Stroke Association, a division of the American Heart Association, after a first stroke, about 1 in 4 people will go on to have another. The majority of recurrent strokes are preventable through the same lifestyle changes, and medication if necessary, that may help prevent a first stroke or other cardiovascular diseases.

In the Brain Attack Surveillance in Corpus Christi (BASIC) Project in South Texas, researchers analyzed the frequency of recurrent stroke between January 1, 2000, and December 31, 2019 among nearly 6,000 first-time ischemic stroke survivors. Half of the stroke survivors were women, and their average age was 69 years. Participants self-identified as Mexican American (52.5%), non-Hispanic white (40.4%) and other races or ethnicities (7.1%).

The analysis found:

  • Overall, nearly 14 out of 100 stroke survivors had a second stroke within about 8 years.
  • In 2000, approximately 11 out of 100 women had a recurrent stroke within one year, compared to 8 out of 100 men.
  • Over the two decades, the risk of recurrent stroke declined among all stroke survivors; however, women experienced twice the decline compared to men. Fewer than 4 out of 100 women experienced a recurrent stroke one year after a first stroke, compared to nearly 5 out of 100 men.
  • Similar results occurred five years after a first stroke, with 8 out of 100 women compared to 10 out of 100 men experiencing a recurrent stroke.

“Secondary stroke prevention has been successful; however, it has not been as effective among male stroke survivors in recent years,” said study lead author Chen Chen, M.S., a Ph.D. candidate in epidemiology at the University of Michigan in Ann Arbor. “We were somewhat surprised that our results showed that in recent years men had similar or even higher chances of having a second stroke compared with women.”

The study had a few limitations. One limitation is that all study participants lived in one South Texas community (Nueces County, Texas), so the results may not apply to people living in other areas. Another limitation is that the study did not include details about subtypes of recurrent stroke, which may point to additional risk factors and the need for more targeted secondary prevention strategies.

“Further research is needed to understand the reasons behind the welcome declining trends in stroke recurrence for both sexes, particularly the reasons for differences over time by sex,” Chen said. “This information will help policymakers understand where to focus efforts that may further improve secondary stroke prevention and reduce or prevent health inequities.”

According to the American Stroke Association, a division of the American Heart Association, worldwide, stroke is the second-leading cause of death after heart disease. Stroke is a medical emergency that occurs when the blood vessels to the brain become blocked, which is an ischemic stroke, the most common type, or they may burst, which is a hemorrhagic stroke. Immediate treatment to restore blood flow and oxygen to the brain may help prevent permanent disability. The abbreviation F.A.S.T. — for face drooping, arm weakness, speech difficulty, time to call 911 — is a useful tool to recognize the warning signs of stroke and when to call for help.

Co-authors are Kevin He, Ph.D.; Mathew J. Reeves, Ph.D.; Lewis B. Morgenstern, M.D.; Karen B. Farris, Ph.D.; and Lynda D. Lisabeth, Ph.D. Authors’ disclosures are listed in the abstract.

The study was funded by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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Poor oral health may contribute to declines in brain health

American Stroke Association International Stroke Conference 2023, Abstract 126

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:


  • Adults who are genetically prone to poor oral health may be more likely to show signs of declining brain health than those with healthy teeth and gums.

  • Early treatment of poor oral health may lead to significant brain health benefits.

DALLAS, Feb. 2, 2023 — Taking care of your teeth and gums may offer benefits beyond oral health such as improving brain health, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually, Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Studies have shown that gum disease, missing teeth and other signs of poor oral health, as well as poor brushing habits and lack of plaque removal, increase stroke risk. According to the American Stroke Association, stroke is the number 5 cause of death and a leading cause of disability in the United States. Previous research has also found that gum disease and other oral health concerns are linked to heart disease risk factors and other conditions like high blood pressure.

“What hasn’t been clear is whether poor oral health affected brain health, meaning the functional status of a person’s brain, which we are now able to understand better using neuroimaging tools such as magnetic resonance imaging or MRI,” said study author Cyprien Rivier, M.D., M.S., a postdoctoral fellow in neurology at the Yale School of Medicine in New Haven, Connecticut. “Studying oral health is especially important because poor oral health happens frequently and is an easily modifiable risk factor – everyone can effectively improve their oral health with minimal time and financial investment.”

Just as healthy lifestyle choices impact the risk of heart disease and stroke, they also affect brain health, which includes one’s ability to remember things, think clearly and function in life. Three in five people in the U.S. will develop brain disease in their lifetime, according to latest estimates from the American Stroke Association, a division of the American Heart Association.

Between 2014 and 2021, researchers in this study analyzed the potential link between oral health and brain health among about 40,000 adults (46% men, average age 57 years) without a history of stroke enrolled in the U.K. Biobank. Participants were screened for 105 genetic variants known to predispose persons to have cavities, dentures and missing teeth later in life, and the relationship between the burden of these genetic risk factors for poor oral health and brain health was evaluated.

Signs of poor brain health were screened via MRI images of the participants’ brains: white matter hyperintensities, defined as accumulated damage in the brain’s white matter, which may impair memory, balance and mobility; and microstructural damage, which is the degree to which the fine architecture of the brain has changed in comparison to images for a normal brain scan of a healthy adult of similar age.

The analysis found:

  • People who were genetically prone to cavities, missing teeth or needing dentures had a higher burden of silent cerebrovascular disease, as represented by a 24% increase in the amount of white matter hyperintensities visible on the MRI images.
  • Those with overall genetically poor oral health had increased damage to the fine architecture of the brain, as represented by a 43% change in microstructural damage scores visible on the MRI scans. Microstructural damage scores are whole-brain summaries of the damage sustained by the fine architecture of each brain region.

“Poor oral health may cause declines in brain health, so we need to be extra careful with our oral hygiene because it has implications far beyond the mouth,” Rivier said. “However, this study is preliminary, and more evidence needs to be gathered – ideally through clinical trials – to confirm improving oral health in the population will lead to brain health benefits.”

The analysis was limited by the fact that the UK Biobank includes only people who reside in the U.K., and they are predominantly of European ancestry (94% of the U.K. Biobank participants reported their race as white vs. 6% reported as mixed, Black British, Asian British or other). In addition, more research among people from diverse racial and ethnic backgrounds is needed.

American Stroke Association, a division of the American Heart Association, Stroke Council member and volunteer expert Joseph P. Broderick, M.D., FAHA, a professor at the University of Cincinnati Department of Neurology and Rehabilitation Medicine and director of the University of Cincinnati Gardner Neuroscience Institute in Cincinnati, Ohio, said while the study results don’t demonstrate that dental hygiene improves brain health, the findings are “intriguing” and should prompt more research.

“Environmental factors such as smoking and health conditions such as diabetes are much stronger risk factors for poor oral health than any genetic marker – except for rare genetic conditions associated with poor oral health, such as defective or missing enamel,” Broderick said. “It is still good advice to pay attention to oral hygiene and health. However, since people with poor brain health are likely to be less attentive to good oral health compared to those with normal brain health, it is impossible to prove cause and effect. Also, genetic profiles for increased risk of oral health may overlap with genetic risk factors for other chronic health conditions like diabetes, hypertension, stroke, infections, etc. that are known to be related to brain imaging markers.“ Broderick was not involved in this study.

Co-authors are Daniela Renedo, M.D.; Adam H. de Havenon, M.D., M.S.C.I.; Sam Pyabvash, M.D.; Kevin N. Sheth, M.D.; and Guido J. Falcone, M.D., Sc.D., M.P.H. Authors’ disclosures are listed in the abstract.

The study was funded by the American Heart Association through the Bugher Center for Hemorrhagic Stroke Research Network (AHA grant #817874). U.K. Biobank data were accessed using project application 58743.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

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