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Query: UMLS:C0038454 (stroke)
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The majority of epidemiological studies on the benefits and risks of oral contraceptive (OC) use have been conducted during the late 1960s and early 1970s when OCs had 50 mcg of estrogen. Based on these studies, the risk of death due to OC use for nonsmokers 35-39 years old was lower than using no contraceptive at all (14.1 deaths/100,000 women/year vs. 25.7 deaths/100,000 women/year). In addition to smoking, other contraindications include women with a history of angina, myocardial infarction, blood clots or stroke, estrogen dependent cancer, hypertension, a known lipid disorder, and women with hepatitis or cirrhosis of the liver. Suitable 35 year old candidates for OC use would be nonsmokers with blood group O, at low risk for cardiovascular disease, and who might receive additional benefits, including those with severe dysmenorrhea or hypermenorrhea and possibly those who have a strong family history of osteoporosis, early menopause, or ovarian cancer. Practitioners should take a thorough history of these women and give a physical examination with a blood pressure check. They should also administer screening tests, such as a PAP test, mammograms, a lipoprotein profile, and a glucose test. After the practitioners have deemed these women to be healthy based on the examination and the results of the screening test, they then should prescribe only a low dose OC containing 50 mcg of estrogen. Today most estrogen based OCs contain 35 mcg and research on their effects have not yet begun. Scientists expect to find that the dose response effects for risks for thromboembolism, myocardial infarction, stroke, and gallbladder disease to be lower in users of the low dose preparations.
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PMID:Risks and benefits of oral contraceptive use in women over 35. 323 16

The influence of the efficacy of triglyceride and cholesterol correction on cardiovascular complications and mortality was analysed in a follow-up study with 260 patients with primary HLP (triglycerides before entry greater than 2.9 mmol/l and/or cholesterol greater than 7.8 mmol/l). The follow-up time was 67.4 +/- 27 months. It was hypothesised that reduction of elevated levels of triglycerides and/or cholesterol influenced favourably the incidence of angina pectoris, MI, stroke and total mortality. For ethical reasons, it was not possible to carry out the investigations with a control group. Therefore, we performed an internal comparison of 3 categories of lipid correction achieved during the trial (effective, moderate, insufficient). A substantial improvement of the lipid disorder was obtained by individualizing the therapy. Triglycerides and cholesterol decreased on average by 50% and 20%, respectively. The incidence of MI was 10 times higher than in the general population. With respect to the type of HLP, hypertriglyceridemia revealed a significantly higher incidence of MI compared with hypercholesterolemia and mixed HLP. The therapy variant was only of importance with respect to gallstone diseases accumulating in the CPIB-treated subgroups. We found a majority of cases with newly manifested angina pectoris and stroke in the group with moderate correction of both triglycerides and cholesterol. Patients with effective triglyceride and cholesterol correction suffered less frequently from MI than those with insufficient correction. This was also the case with secondary prevention in cases with MI prior to entry. There was no significant difference in the distribution of lipid categories at entry between those with and without recurrent infarction. In the group without reinfarction, however, the percentage with insufficient control diminished significantly. Associated risk factors such as hypertension, diabetes, smoking and obesity were of minor or no significance. In subjects with effective triglyceride correction, the total mortality was 0.97/1000 treatment months vs. 3.63 in insufficiently treated patients. The figures for MI mortality were 0.36 and 1.91, respectively.
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PMID:Reduced incidence of cardiovascular complications and mortality in hyperlipoproteinemia (HLP) with effective lipid correction. The Dresden HLP study. 649 44

Proportion of severe cases and mortality in stroke patients has decreased steadily in the Minami-Uwa District. The reason for this, has been assumes to be that severe hypertensive patients were being detected and treated in early stage by the increase in response rate of medical check-up and from improvements in health education in cooperation with the Mishou Public Health Center in the towns and Villages in the District. However, as there are multiple risk factors for hypertensive circulatory disease other then it is necessary to determine what factors exist in hypertensive patients. Risk factors for circulatory disease were studied in patients using antihypertensive medication at the time of the health examination. Of 5,284 residents studied from 1993 to 1994 the prevalence of risk factors of atherosclerosis such as obesity, disorders of lipid metabolism and glucose intolerance were higher in hypertensive who were normotensive due to antihypertensive drugs than in the non-hypertensive residents. Patients with resistant hypertension accounted for a third of all the patients using antihypersive drugs. Results also showed a relationship between excessive reduction in diastolic blood pressure and increased risk of coronary heart disease (the J-curve phenomenon) in patients on antihypertensive drug treatment. For preventing circulatory disease, it is important to improve the life style of hypertensive patients, in areas such as physical activity or dietary habits, and develop close cooperation among doctors, public health nurses and nutritionists in the regional community, in addition to increasing compliance in maintaining antihypertensive treatment. Construction of a network among public health, medical care and welfare services is important for prevention and for an improved prognosis in circulatory disease.
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PMID:[Risk factors for circulatory disease in patients on antihypertensive drug treatment]. 961 91

In order to have basic data for dietary preventive measures against some vascular diseases caused by disorder of lipid metabolism, food intake and lipid status were investigated in three Vietnamese populations with different per capita income levels. Totally, 299 people aged over 18 were involved in this study. Among them, 98 subjects were selected from one commune with low income, 100 and 101 subjects from two urban areas with medium and high income respectively. Food intake was assessed by 24-h recall method and lipid status was evaluated by measuring serum concentration of triglyceride, total cholesterol and its subfractions. The results showed that food consumption, dietary habits and lipid status varied with income levels. In general, diet was still unbalanced in all three groups, and low in fat and protein. In the rural, fat and protein intakes were lower than in the urban. The high prevalence of low serum cholesterol was observed in all three groups, the highest in the rural (45.3%) and the lowest in the urban (11.2%). On the contrary, the prevalence of high serum cholesterol was the lowest in the rural (2%) and the highest in the urban (16%). From these data, it is suggested that the majority of the Vietnamese might be vulnerable to some vascular diseases such as stroke if the situation of low fat intake and low serum cholesterol is not a problem of concern.
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PMID:Food intake and lipid status of three Vietnamese populations with different incomes. 1134 93

The efficacy of lipid disorder therapy for the primary and secondary prevention of coronary heart disease is established. There are, however, no completed studies specifically directed at reducing the risk of stroke with lipid therapy. Although observational cohort studies have failed to demonstrate an association between lipid disorders and stroke incidence, recently completed trials of subjects at risk for coronary heart disease have shown that statins and fibric acid derivatives reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. Lipid drugs are well tolerated and treatment complications are relatively low. It seems prudent to conclude that the stroke patient with an undesirable lipid profile who has a history of coronary heart disease should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorders but no history of coronary heart disease; most should receive therapy for primary prevention of heart disease. Lipid treatment trials focused on stroke risk reduction are urgently needed.
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PMID:Treatment of lipid disorders after stroke. 1205 82

This study was done to establish the relationship between disorders of lipid metabolism and risk factors of ischemic cerebrovascular stroke, search for correlations between disorders of lipid metabolism and severity of ischemic stroke, and assess the association between fibrinogen levels in serum and risk factors in patients suffering from different types of ischemic stroke. Altogether, 117 patients were enrolled, including 76 males and 41 females aged 20 to 55 years (mean--45.3 years). The patients were divided into three groups depending on the dynamics of neurological symptoms: (1) transient ischemic attacks (TIA); (2) reversible ischemic neurologic deficit (RIND); (3) completed stroke (CS). The diagnosis was based on history-taking, physical examination, laboratory tests and neuro-imaging studies. The tests included a complete blood count, glucose, glucose tolerance, 24-hour glucose profile, coagulation profile, fibrinogen, total cholesterol, triglycerides, HDL and LDL cholesterol fractions, and beta-lipoproteins. Blood was collected on the first day of hospitalization prior to any medication. An ECG, CT, and Doppler USG of carotid vessels were done. Cardiac etiology of stroke was ruled out with Holter ECG and echocardiography. The results were subjected to statistical analysis with Yule's coefficient for two qualitative variables. Lipid disorders usually co-existed with obesity, fat-rich diets and sedentary lifestyle in all ischemic stroke types studied. They were accompanied by elevated blood pressures in every type of stroke and by diabetes in TIA. Lipid disorders were found to co-exist with other risk factors for ischemic stroke predominantly in female patients, while in male patients these disorders were an independent risk factor for ischemic stroke. The extent of lipid disorders correlated with the severity of ischemic stroke. Elevated levels of fibrinogen in serum were detected in female patients in every type of stroke. In male patients, elevated fibrinogen was found only in TIA and co-existed with high blood pressure, diabetes and obesity.
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PMID:[Metabolic disturbances and prognosis in ischemic cerebrovascular stroke in patients up to 55 years of age]. 1460 83

This study examined stroke risk factor profiles, management and outcomes for elderly patients with English-speaking background (ESB) and non-English-speaking background (NESB). This is an observational cohort study with both retrospective and prospective components. In total, 186 consecutive acute stroke patients aged > or =65 years admitted to our hospital were recruited over a 12-month period. Patient characteristics, stroke risk factors and management, in-hospital mortality, functional independence measurement scores before admission and at discharge, and discharge destination were recorded. On admission, NESB patients with atrial fibrillation (AF) were less likely to be taking warfarin than ESB patients (1 out of 19 with NESB vs. 19 out of 41 with ESB, p = 0.001). More NESB patients had a history of diabetes mellitus (DM) than ESB patients (41.4 vs. 10.2%, respectively; p = 0.001). However, ESB and NESB patients were comparable in terms of age, gender, preadmission functional status as well as other stroke risk factors (including smoking and alcohol drinking pattern, prevalence of hypertension and lipid disorder) and their management. In-hospital mortality was similar between ESB and NESB patients (10.2 vs. 8.6%). In conclusion, we found an association with our population of elderly NESB patients and an underutilization of warfarin for AF as well as a higher frequency of DM. Determination of the underlying reasons for such differences may be of value in the primary health care of NESB patients.
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PMID:Comparison of stroke risk factors and outcomes in patients with English-speaking background versus non-English-speaking background. 1545 14

To study hereditary predisposition to stroke in main ethnic groups of Izhevsk, 210 patients born in ethnically homogenous marriages have been examined and the data on state of health of 1701 relatives over 40 years old have been obtained. A role of hereditary factor in development of stroke was revealed. Also, there were ethnic differences related to a prevalence of carbohydrate-lipid metabolism disorder in patients of the Tartar group comparing to Udmurt and Russians.
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PMID:[Ethnic and genealogical aspects of cerebral stroke in Izhevsk city]. 1644 58

Data concerning the treatment of lipoprotein disturbances in patients with cerebrovascular disease (CVD) are less robust than those for coronary heart disease (CHD), raising clinical questions as to which is the appropriate therapeutic approach to stroke patients. Although observational cohort studies have failed to demonstrate an association between lipoprotein disorders and stroke incidence, recently completed trials of subjects at risk for CHD have shown that statins reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. At present, it seems reasonable to conclude that stroke patients with undesirable lipid profiles who have a history of CHD should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorder but no history of CHD. Furthermore, many of the risk factors for CVD and vascular dementia (VaD), including serum total cholesterol (TC), lipoprotein(a), diabetes, atrial fibrillation, hypertension, apolipoprotein E levels, and atherosclerosis, have also been shown to increase the risk of Alzheimer's disease (AD). In a recent study, we estimated the prevalence, incidence and rate of progression of Mild Cognitive Impairment (MCI) to dementia, and correlated vascular risk factors with incident MCI and its progression to dementia. We evaluated 2963 individuals from the population-based sample of 5632 subjects 65-84 years old of the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. We found a progression rate to dementia (all causes) of 3.8/100 person-years. Furthermore, age was a risk factor for incident MCI, while education was protective, and serum TC evidenced a non-significant borderline trend for a protective effect. There was a non-significant trend for stroke as a risk factor of progression of MCI to dementia. In conclusion, in our population, among MCI patients who progressed to dementia, 60% progressed to AD and 33% to VaD. Vascular risk factors and CVD may influence the development of MCI and the rate of progression to dementia.
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PMID:Cerebrovascular disease in the elderly: lipoprotein metabolism and cognitive decline. 1670 84

Several studies have shown the occurrence of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease, including arterial hypertension, ischemic heart disease, and stroke. The pathogenesis of the cardiovascular complications of OSAS is still poorly understood, however. Several mechanisms are likely to be involved, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormality in the process of coagulation, and metabolic dysregulation. The latter may involve insulin resistance and disorders of lipid metabolism. The aim of this review, which reports the data presented at a workshop jointly endorsed by the European Society of Hypertension and by the European Union COST action on OSAS (COST B26), is to critically summarize the evidence available to support an independent association between OSAS and cardiovascular disease.
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PMID:Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk. 1765 56


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