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Archive for the ‘cerebrovascular disease’ Category

Mortality from road crashes in 193 countries: a comparison with other leading causes of death

February 26, 2014 Comments off

Mortality from road crashes in 193 countries: a comparison with other leading causes of death
Source: Transportation Research Institute (University of Michigan)

This study compared, for each country of the world, the fatalities per population from road crashes with fatalities per population from three leading causes of death (malignant neoplasm, ischaemic heart disease, and cerebrovascular disease), and from all causes. The data, applicable to 2008, came from the World Health Organization. The main findings are as follows:
(1) For the world, there are 18 fatalities from road crashes per 100,000 population, as compared with 113 for malignant neoplasm, 108 for ischaemic heart disease, and 91 for cerebrovascular disease. The highest fatality rate from road crashes is in Namibia (45) and the lowest in the Maldives (2).
(2) For the world, fatalities from road crashes represent 2.1% of fatalities from all causes. The highest percentage is in the United Arab Emirates (15.9%) and the lowest in the Marshall Islands (0.3%).
(3) For the world, fatalities from road crashes represent 15.9% of fatalities from malignant neoplasm. The highest percentage is in Namibia (153.9%) and the lowest in the Maldives (1.7%).
(4) For the world, fatalities from road crashes represent 16.7% of fatalities from ischaemic heart disease. The highest percentage is in Qatar (123.9%) and the lowest in Malta (1.9%).
(5) For the world, fatalities from road crashes represent 19.6% of fatalities from cerebrovascular disease. The highest percentage is in Qatar (529.7%) and the lowest in the Marshall Islands (2.3%). The appendixes list the rates and percentages for each individual country.

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AHA/ASA Guidelines for the Prevention of Stroke in Women

February 7, 2014 Comments off

AHA/ASA Guidelines for the Prevention of Stroke in Women
Source: Stroke

Purpose
The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation.

Methods
Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

Results
We provide current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura.

Conclusions
To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted.

Sodium Intake in Populations: Assessment of Evidence

September 17, 2013 Comments off

Sodium Intake in Populations: Assessment of Evidence
Source: Institute of Medicine

Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease.

A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk.

Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse—that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality.

Vital Signs: Avoidable Deaths from Heart Disease, Stroke, and Hypertensive Disease — United States, 2001–2010

September 9, 2013 Comments off

Vital Signs: Avoidable Deaths from Heart Disease, Stroke, and Hypertensive Disease — United States, 2001–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

Methods: National Vital Statistics System mortality data for the period 2001–2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

Results: In 2010, an estimated 200,070 avoidable deaths from heart disease, stroke, and hypertensive disease occurred in the United States, 56% of which occurred among persons aged <65 years. The overall age-standardized death rate was 60.7 per 100,000. Rates were highest in the 65–74 years age group, among males, among non-Hispanic blacks, and in the South. During 2001–2010, the overall rate declined 29%, and rates of decline varied by age.

Conclusions: Nearly one fourth of all cardiovascular disease deaths are avoidable. These deaths disproportionately occurred among non-Hispanic blacks and residents of the South. Persons aged <65 years had lower rates than those aged 65–74 years but still accounted for a considerable share of avoidable deaths and demonstrated less improvement.

CDC Vital Signs — Preventable Deaths from Heart Disease & Stroke

September 4, 2013 Comments off

CDC Vital Signs — Preventable Deaths from Heart Disease & Stroke
Source: Centers for Disease Control and Prevention

Nearly 1 in 3 deaths in the US each year is caused by heart disease and stroke. At least 200,000 of these deaths could have been prevented through changes in health habits, such as stopping smoking, more physical activity, and less salt in the diet; community changes to create healthier living spaces, such as safe places to exercise and smoke-free areas; and managing high blood pressure, high cholesterol, and diabetes.

More people will have access to health care coverage and preventive care through the Affordable Care Act. Health care providers should talk with their patients about healthy habits at every visit and follow patients’ progress.

Health care systems and providers can also:

  • Use electronic health records to identify and support patients who need help quitting smoking or who have high blood pressure or high cholesterol.
  • Refer patients to community resources, such as smoking quitlines and blood pressure selfmanagement programs.
  • Track patient progress on the ABCS of heart health—Aspirin when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation.

Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases

July 19, 2013 Comments off

Evaluation of Excess Significance Bias in Animal Studies of Neurological Diseases
Source: PLoS Biology

Animal studies generate valuable hypotheses that lead to the conduct of preventive or therapeutic clinical trials. We assessed whether there is evidence for excess statistical significance in results of animal studies on neurological disorders, suggesting biases. We used data from meta-analyses of interventions deposited in Collaborative Approach to Meta-Analysis and Review of Animal Data in Experimental Studies (CAMARADES). The number of observed studies with statistically significant results (O) was compared with the expected number (E), based on the statistical power of each study under different assumptions for the plausible effect size. We assessed 4,445 datasets synthesized in 160 meta-analyses on Alzheimer disease (n = 2), experimental autoimmune encephalomyelitis (n = 34), focal ischemia (n = 16), intracerebral hemorrhage (n = 61), Parkinson disease (n = 45), and spinal cord injury (n = 2). 112 meta-analyses (70%) found nominally (p≤0.05) statistically significant summary fixed effects. Assuming the effect size in the most precise study to be a plausible effect, 919 out of 4,445 nominally significant results were expected versus 1,719 observed (p<10−9). Excess significance was present across all neurological disorders, in all subgroups defined by methodological characteristics, and also according to alternative plausible effects. Asymmetry tests also showed evidence of small-study effects in 74 (46%) meta-analyses. Significantly effective interventions with more than 500 animals, and no hints of bias were seen in eight (5%) meta-analyses. Overall, there are too many animal studies with statistically significant results in the literature of neurological disorders. This observation suggests strong biases, with selective analysis and outcome reporting biases being plausible explanations, and provides novel evidence on how these biases might influence the whole research domain of neurological animal literature.

Surveillance for Certain Health Behaviors Among States and Selected Local Areas — United States, 2010

June 5, 2013 Comments off

Surveillance for Certain Health Behaviors Among States and Selected Local Areas — United States, 2010

Source: Morbidity and Mortality Weekly Report (CDC)

Chronic diseases (e.g., heart disease, stroke, cancer, and diabetes) are the leading causes of morbidity and mortality in the United States. Engaging in healthy behaviors (e.g., quitting smoking and tobacco use, being more physically active, and eating a nutritious diet) and accessing preventive health-care services (e.g., routine physical checkups, screening for cancer, checking blood pressure, testing blood cholesterol, and receiving recommended vaccinations) can reduce morbidity and mortality from chronic and infectious disease and lower medical costs. Monitoring and evaluating health-risk behaviors and the use of health services is essential to developing intervention programs, promotion strategies, and health policies that address public health at multiple levels, including state, territory, metropolitan and micropolitan statistical area (MMSA), and county.

The findings in this report indicate substantial variations in the health-risk behaviors, chronic diseases and conditions, access to health-care services, and the use of the preventive health services among U.S. adults at the state and territory, MMSA, and county levels. Healthy People 2010 (HP 2010) objectives were established to monitor health behaviors, conditions, and the use of preventive health services for the first decade of the 2000s. The findings in this report indicate that many of the HP 2010 objectives were not achieved by 2010. The findings underscore the continued need for surveillance of health-risk behaviors, chronic diseases, and conditions and of the use of preventive health-care services.

Self-Reported Hypertension and Use of Antihypertensive Medication Among Adults — United States, 2005–2009

April 5, 2013 Comments off

Self-Reported Hypertension and Use of Antihypertensive Medication Among Adults — United States, 2005–2009
Source: Morbidity and Mortality Weekly Report (CDC)

Hypertension affects one third of adults in the United States (1) and is a major risk factor for heart disease and stroke (2). A previous report found differences in the prevalence of hypertension among racial/ethnic populations in the United States; blacks had a higher prevalence of hypertension, and Hispanics had the lowest use of antihypertensive medication (3). Recent variations in geographic differences in hypertension prevalence in the United States are less well known (4). To assess state-level trends in self-reported hypertension and treatment among U.S. adults, CDC analyzed 2005–2009 data from the Behavioral Risk Factor Surveillance System (BRFSS). The results indicated wide variation among states in the prevalence of self-reported diagnosed hypertension and use of antihypertensive medications. In 2009, the age-adjusted prevalence of self-reported hypertension ranged from 20.9% in Minnesota to 35.9% in Mississippi. The proportion reporting use of antihypertensive medications among those who reported hypertension ranged from 52.3% in California to 74.1% in Tennessee. From 2005 to 2009, nearly all states had an increased prevalence of self-reported hypertension, with percentage-point increases ranging from 0.2 for Virginia (from 26.9% to 27.1%) to 7.0 for Kentucky (from 27.5% to 34.5%). Overall, from 2005 to 2009, the prevalence of self-reported hypertension among U.S. adults increased from 25.8% to 28.3%. Among those reporting hypertension, the proportion using antihypertensive medications increased from 61.1% to 62.6%. Increased knowledge of the differences in self-reported prevalence of hypertension and use of antihypertensive medications by state can help in guiding programs to prevent heart disease, stroke, and other complications of uncontrolled hypertension, including those conducted by state and local public health agencies and health-care providers.

Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009

September 7, 2012 Comments off

Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009
Source: Morbidity and Mortality Weekly Report (CDC)

High blood cholesterol is a leading risk factor in the development of atherosclerosis and coronary heart disease (CHD) (1,2). The risks associated with high blood cholesterol can be reduced by screening and early intervention (3). Current clinical practice guidelines provide evidenced-based standards for detection, treatment, and control of high blood cholesterol (4). Healthy People 2020 monitors national progress related to screening and controlling high blood cholesterol through the National Health Interview Survey and the National Health and Nutrition Examination Survey (NHANES). State-level estimates of self-reported cholesterol screening and high blood cholesterol prevalence are available using Behavioral Risk Factor Surveillance System (BRFSS) data. To assess recent trends in the percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years, and the percentage among those who had been screened within the previous 5 years and who were ever told they had high blood cholesterol, CDC analyzed BRFSS data from 2005, 2007, and 2009. The results of that analysis showed that the percentage of adults reporting having been screened for high blood cholesterol within the preceding 5 years increased overall from 72.7% in 2005 to 76.0% in 2009. In addition, the percentage who had ever been told they had high cholesterol increased from 33.2% to 35.0%. Both self-reported screening and high cholesterol varied by state and sociodemographic subgroup. To reach the Healthy People 2020 target for cholesterol screening, public health practitioners should emphasize the importance of screening, especially among younger adults, men, Hispanics, and persons with lower levels of education.

Adults experiencing mental illness have higher rates of certain chronic physical illnesses

April 16, 2012 Comments off
Source:  Substance Abuse and Mental Health Services Administration
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.
For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those not experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.
Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease and stroke than people who did not experience serious mental illnesses.
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).

Full Report (PDF)

Trust for America’s Health Releases Healthier Americans for a Healthier Economy

November 3, 2011 Comments off

Trust for America’s Health Releases Healthier Americans for a Healthier Economy
Source: Trust for America

Trust for America’s Health (TFAH) released a new report, Healthier Americans for a Healthier Economy, featuring six case studies focused on the relationship between health and economic development. The report examines how health affects the ability of states, cities and towns to attract and retain employers, and how workplace and community wellness programs help improve productivity and reduce health spending.

“High rates of chronic diseases, like diabetes and heart disease, are among the biggest drivers of U.S. health care costs and they are harming our nation’s productivity,” said Jeff Levi, PhD, Executive Director of TFAH, and Chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. “Workplace wellness and community prevention programs are a win-win way to make a real difference in improving our health and bottom line all at once.”

According to the report, more than half of all Americans currently live with one or more chronic disease, including heart disease, stroke, diabetes and cancer. High rates of these diseases, which in many cases are preventable, are associated with increasing health care costs.

The case studies in the report feature first-hand accounts from business executives, elected officials and public health leaders in Minnesota, Texas, Nashville, Indiana, San Diego and Hernando, Mississippi, where employers and communities are making the connection between improving health and improving the economy.

+ Full Report

Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention

November 2, 2011 Comments off

Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention (PDF)
Source: Agency for Healthcare Research and Quality

A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories: (1) hospital-initiated support for discharge was the initial stage in the transition of care process, (2) patient and family education interventions were started during hospitalization but were continued at the community level, (3) community-based models of support followed hospital discharge, and (4) chronic disease management models of care assumed the responsibility for long-term care. Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient- or system-based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was inconsistency in the definition of what constituted a component of transition of care compared to “standard care.” Standard care was poorly defined, and nearly all studies were underpowered to demonstrate a statistical benefit. The endpoints varied greatly from study to study. Nearly all the studies were single-site based, and most (26 of 44) were conducted in countries with national health care systems quite different from that of the U.S., therefore limiting their generalizability.

Apixaban versus Warfarin in Patients with Atrial Fibrillation

August 29, 2011 Comments off

Apixaban versus Warfarin in Patients with Atrial Fibrillation
Source: New England Journal of Medicine

In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. (Funded by Bristol-Myers Squibb and Pfizer; ARISTOTLE ClinicalTrials.gov number, NCT00412984.)

Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study

July 8, 2011 Comments off

Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study
Source: Annals of Neurology

Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt. ANN NEUROL 2011

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is an epidemiological study following a cohort of US adults for stroke and cognitive decline. In reports from REGARDS, self-reported stroke symptoms in the absence of diagnosed stroke were considered as potential markers of ischemic changes. Such symptoms, reported by 18% of REGARDS participants,1 were associated with a 24% increased risk of prevalent cognitive impairment after controlling for age, sex, race, education, and region of residence.2 Decrements in cognitive function may serve in some cases as a proxy for unrecognized small strokes,2 a notion that is supported by demonstrated associations between magnetic resonance imaging-defined silent brain infarcts, cognitive deficits, and incident dementia.3–7 It is not known, however, whether incidence of cognitive impairment is elevated in the Stroke Belt region of the United States, a region of the southeastern United States first described in 1965 as having 50% higher stroke mortality rates than the remaining United States.8 Centers for Disease Control and Prevention state statistics from 2000 to 2006 reveal that among adults aged 35 years and older, age-adjusted annual rates of stroke mortality in the 8 Stroke Belt states were, on average, 125 per 100,000, compared to an average rate of 96 per 100,000 in the remaining 40 contiguous states and the District of Columbia.9 During the same period, age-adjusted stroke hospitalization rates among Medicare beneficiaries aged 65 years and older followed a similar pattern of higher concentration in the Stroke Belt.9

It is plausible that incidence of cognitive impairment might be elevated in the Stroke Belt due to subclinical strokes and cerebrovascular disease as well as to precursor or concomitant risk factors for both stroke and cognitive impairment, such as hypertension, diabetes, kidney disease, and metabolic syndrome.10–16 The purpose of the present analysis from the REGARDS study was to examine incident impairment in cognitive screening status in the southern Stroke Belt region relative to the remaining 40 contiguous states. Among participants who had intact cognitive screening status at baseline and no history of stroke, we predicted regional differences in incident cognitive impairment that reflect well-documented regional differences in stroke incidence and mortality. Specifically, we hypothesized that there would be greater occurrence of incident impairment in cognitive screening performance in the Stroke Belt relative to the rest of the United States.

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