Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study
Nawaz, Beenish; Fromm, Annette; Øygarden, Halvor; Eide, Geir E.; Saeed, Sahrai; Meijer, Rudy; Bots, Michiel L.; Sand, Kristin M.; Thomassen, Lars; Næss, Halvor; Waje-Andreassen, Ulrike
(2021) European Stroke Journal, volume 6, issue 4, pp. 374 - 384
(Article)
Abstract
Objectives: We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up. Methods: Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven
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vascular areas by electrocardiogram (ECG), ankle–arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied. Results: Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients (p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients (p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls. Conclusion: Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death.
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Keywords: Trial of Org 10172 in Acute Stroke Treatment (TOAST), Young ischaemic stroke, abdominal aorta plaques, ankle-arm index, atherosclerosis, cardiovascular events, carotid intima-media thickness, femoral intima-media thickness, long-term outcome, mortality
ISSN: 2396-9873
Publisher: SAGE Publications Inc.
Note: Funding Information: We are indebted to our study nurses, Linn Elin Rødal, Maria Sætveit Stokkan and Toril Synnøve Sormerud, and the secretary, Jeanette Haveland Antoniazzi, for their dedication and help. This research was funded by the Western Norway Health Trust, which had no influence on the study design, data collection and presentation or the conclusions made. Publisher Copyright: © European Stroke Organisation 2021.
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