American Stroke Association, Feb. 6-8

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The American Heart Association International Stroke Conference 2019

The annual International Stroke Conference of the American Heart Association/American Stroke Association (AHA/ASA) was held from Feb. 6 to 8 in Honolulu and attracted nearly 4,000 participants from around the world, including cerebrovascular research and practice experts. The conference featured more than 1,500 presentations that emphasized basic, clinical, and translational medicine as well as provided insight into the prevention, management, and treatment of stroke.

In one study, Dinesh V. Jillella, M.D., of the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, and colleagues found that risk factors for cerebrovascular disease were common and increasing among Native Americans.

"With recent data showing high prevalence of stroke and stroke-related mortality in Native Americans compared to the other ethnic groups in the United States, we aimed to see if this translated to cerebrovascular risk factor prevalence," Jillella said.

The investigators extracted data from the Cerner electronic health records database, a registry that includes approximately 700 U.S. hospitals nationwide. Demographic data and cerebrovascular risk factors were prospectively analyzed from 4,729 Native Americans (54 percent female) who had been diagnosed with ischemic stroke from 2000 to 2016.

"We found that over the time period between 2000 to 2016, there was a statistically significant increase in all the cerebrovascular risk factors we evaluated for (hypertension, smoking, coronary artery disease, atrial flutter, atrial fibrillation, and heart failure) except diabetes mellitus," Jillella said. "Ischemic strokes constitute more than 80 percent of all strokes combined, and identification of increase in risk factors, especially in specific ethnic groups like the Native Americans with health and socioeconomic disparities, can help us target these risk factors as a means to reducing stroke burden going forward."

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In another study, Eliza C. Miller, M.D., of the Columbia University Irving Medical Center in New York City, and colleagues found that women who are diagnosed with infections during delivery hospitalizations are at higher risk for postpartum ischemic stroke.

"Rates of postpartum stroke have been increasing in the United States," Miller said. "Infections have been associated with strokes during delivery hospitalizations, but it is unknown whether infections during delivery hospitalizations contribute to the risk of postpartum stroke."

The researchers used data from the Healthcare Cost and Utilization Project National Readmissions Database from 2010 to 2014 to investigate whether having an infection diagnosed during a delivery hospitalization increased the risk of readmission for stroke within 30 days of delivery. The authors excluded transient ischemic attack and cerebral venous sinus thrombosis. There were 17.2 million delivery hospitalizations during the study period; of these women, 2,128 were readmitted within 30 days for a hemorrhagic or ischemic stroke (incidence, 12.4 per 100,000 deliveries).

"Overall, 5.1 percent of women had infections during their delivery hospitalizations. However, among women who went on to be readmitted for stroke, 7.3 percent had infections. Controlling for other risk factors, women who had infections during delivery hospitalizations had a 19 percent higher risk of being readmitted for postpartum stroke," Miller said. "Looking at ischemic and hemorrhagic stroke separately, there was no effect of infection on risk of hemorrhagic postpartum stroke. However, women with delivery infections had 75 percent increased risk of readmission for postpartum ischemic stroke."

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As part of the Stroke Hyperglycemia Insulin Network Effort (SHINE) study, Karen C. Johnston, M.D., of the University of Virginia in Charlottesville, and colleagues assessed the efficacy and safety of an intensive glucose control protocol with a target glucose of 80 to 130 mg/dL compared to a more standard protocol with a target of less than 180 mg/dL. The investigators found that intensive treatment did not improve outcome and increased the risk of severe hypoglycemia.

"The SHINE trial provides us with the highest level of data that intensive glucose control to target 80 to 130 mg/dL is not beneficial and increases risk of hypoglycemia. Our data suggest that the approach of lowering the glucose to below 180 mg/dL is the preferred therapy," Johnston said. "The SHINE trial fills a knowledge gap that has been of concern in the AHA/ASA stroke guidelines and across the world about how best to treat hyperglycemic acute ischemic stroke patients. These data will guide the clinical community in treating this population of patients."

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Longjian Liu, M.D., Ph.D., of the Dornsife School of Public Health at Drexel University in Philadelphia, and colleagues found that air pollution is strongly associated with an increased risk of death from stroke, as well as an increased risk of lower life expectancy.

"To reduce the risk of stroke, clinicians should consider their patients' likely exposure to air pollution along with other risk factors. They can ask patients whether they live or work in an urban industrial area or whether they are aware of sources of pollution near their home or workplace," Liu said in a press release. "Clinicians can then encourage at-risk patients to take measures to reduce their exposure when possible, such as avoiding major roadways during rush hour traffic, keeping car windows closed and setting the air conditioner to circulate internal air."

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ASA: Intensive BP Control Lowers Bleeding Risk in Stroke Patients

TUESDAY, Feb. 12, 2019 (HealthDay News) -- Stroke patients who receive intensive blood pressure lowering are less likely to suffer brain bleeds when treated with clot-busting therapies, according to a study published online Feb. 7 in The Lancet to coincide with the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

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ASA: Opioid Epidemic Tied to Infection-Related Stroke

TUESDAY, Feb. 12, 2019 (HealthDay News) -- The opioid epidemic is driving a steep increase in infection-related stroke hospitalizations, according to a study published online Jan. 30 in Stroke to coincide with the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

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ASA: Reversal Agent Cuts Severe Bleeding With Factor Xa Inhibitors

MONDAY, Feb. 11, 2019 (HealthDay News) -- The reversal agent, andexanet alfa, effectively reduces life-threatening bleeding in patients treated with factor Xa inhibitors, according to a study published online Feb. 7 in the New England Journal of Medicine to coincide with the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

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ASA: Flu-Like Illness Linked to Increased Risk for Stroke

WEDNESDAY, Jan. 30, 2019 (HealthDay News) -- Influenza-like illness is associated with an increased risk for ischemic stroke and cervical artery dissection, according to two studies presented at the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

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ASA: Increased Odds of Stroke, MI With E-Cigarette Use

WEDNESDAY, Jan. 30, 2019 (HealthDay News) -- Electronic cigarette use is associated with increased odds of stroke, myocardial infarction, and angina or coronary heart disease, according to a study presented at the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

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