Research Highlights: Opportunities for Stroke Detection and Prevention

Silent Ischemic Lesions Predict Recurrent Stroke in Those Under 50

Silent ischemic lesions (SILs) on baseline brain MRI are common and independently predict recurrent stroke in adults ≤50 years old with first-ever ischemic stroke, new data show. (Neurology; 79(12):1208-14) Results come from a single-center retrospective study of 170 patients 18 to 50 years old with first-ever ischemic stroke investigated by brain MRI between 2002 and 2009. MRI demonstrated SILs in 48 of 170 (28.2 percent of) patients. Hypertension (p = 0.049), migraine with aura (p = 0.02), and cardiovascular disease (p = 0.04) were associated with SIL.

Among patients with SILs, 11 of 48 patients (23 percent) had a recurrent stroke, compared to eight of 122 (6.5 percent) patients without SIL (p = 0.003).

Women May Have Higher Life Satisfaction Post-Stroke

Women may have higher life satisfaction (LS) than men two years post-stroke, new research suggests. According to results of the study (BMC Neurol;12(1):105), occupational status and memory function may also correlate with life satisfaction.

Researchers identified all stroke patients admitted to all hospitals in Luxembourg with confirmed diagnosis of stroke. The analyzed sample included 94 patients living at home (mean age 65.5 years) and 62 main caregivers (mean age 59.3 years). Questionnaires were completed during face-to-face interviews. LS was assessed via European single question (range 1--10), survivors’ QoL via Newsqol (11 dimensions), and caregivers’ QoL via Whoqol-bref (4 domains) (range 0--100).

Two years after stroke onset, a significant proportion of patients suffered from impairments of sensory function (44.7 percent), motor function (35.1 percent), and memory function (31.9 percent). Mean patient LS was 7.1/10 (SD 1.9). LS was more than 12 points higher in women, and about 13 points lower among unemployed socioeconomically active patients, compared to retired people.

Adjusted for sex, occupation, impaired motor, and memory functions, LS positively correlated with scores of Newsqol feelings, sleep, emotion, cognition and pain dimensions, but did not correlate with those of caregivers’ Whoqol-bref domains. Family caregiver’ LS was 7.2. Caregivers of those with impaired memory function and those with feelings and emotion issues had lower LS scores.

Sweet Findings Link Chocolate to Reduced Stroke Risk

Moderate chocolate consumption in men may be associated with a reduction in stroke risk, a new study and meta-analysis concludes. (Neurology.;79(12):1223-9)

A food-frequency questionnaire was used to assess baseline chocolate consumption for 37,103 men in the Cohort of Swedish Men. Researchers prospectively followed the men, and cases of first stroke were ascertained from the Swedish Hospital Discharge Registry.

During 10.2 years of follow-up, there were 1,995 incident stroke cases, including 1,511 cerebral infarctions, 321 hemorrhagic strokes, and 163 unspecified strokes. The multivariable relative risk of stroke comparing the highest quartile of chocolate consumption (median 62.9 g/week) with the lowest quartile (median 0 g/week) was 0.83 (95 % CI 0.70-0.99). There was no difference in association by stroke subtypes.

A companion meta-analysis of five studies involving a total of 4,260 stroke cases found the overall relative risk of stroke for the highest versus lowest category of chocolate consumption was 0.81 (95% CI 0.73-0.90), without heterogeneity among studies (p = 0.47).

CAPS Findings Suggest Benefit for Carotid Ultrasound

Carotid ultrasound that includes the internal carotid segments as well as the common carotid artery may improve stroke risk classification of individuals, new data suggest, though researchers urge further validation in a primary prevention cohort. (Eur J Prev Cardiol. 2012 May 22, E-pub)

Data come from the Carotid Atherosclerosis Progression Study (CAPS), for which 4,995 subjects had baseline ultrasounds and assessment of conventional stroke risk factors. Strokes, transient ischemic attacks (TIA), and deaths were recorded during 10-year follow-up.

Most risk models were not improved by carotid ultrasound. In fact, for individual stroke prediction, intimamedia thickness (IMT) or plaque of the internal carotid arteries were more useful predictors than common carotid or bifurcational IMT. However, the model predicting “any stroke or death” was significantly improved when ultrasound parameters were included: 339 subjects (7.2 percent; 122 were shifted to a higher risk category, 217 were shifted to a lower risk category). Ultimately, just over half (53.7 percent, n=182) were correctly reclassified. The net reclassification improvement (NRI) was 7.7 percent (p = 0.029).