Air pollution may fuel severe stroke in poor neighborhoods
Higher concentrations of particulate matter from air pollution may amplify severe stroke in socioeconomically disadvantaged neighborhoods, according to research presented at the American Stroke Association’s International Stroke Conference 2015.
Researchers analyzed the potential synergistic effects of living in socioeconomically disadvantaged neighborhoods and air pollution on stroke severity in a bi-ethnic (53 percent Mexican-American and 47 percent non-Hispanic White) U.S. community. Air pollution levels were based on particulate matter and ozone concentrations and neighborhood socioeconomic status was defined using a composite score of census measures.
- Of the 3,035 ischemic strokes that occurred in the study population between 2000 and 2012, people in the most socioeconomically disadvantaged neighborhoods were at 24 percent greater odds of severe stroke compared to people in the least socioeconomically disadvantaged neighborhoods.
- The odds of severe stroke were greater when previous day ozone levels were higher, regardless of neighborhood socioeconomic neighborhood status.
- Higher particulate matter levels amplified the odds of severe stroke in socioeconomically disadvantaged neighborhoods.
Jeffrey James Wing, M.P.H., University of Michigan, Ann Arbor, Mich.
Clot buster use rises most among 80 and older stroke patients
Use of the clot busting drug tissue plasminogen activator (tPA) for ischemic stroke has increased for every age group in recent years. But the magnitude of change has been greatest among the very elderly, 80 years and older, researchers report at the American Stroke Association’s International Stroke Conference 2015.
Historically, rates of tPA administration in patients ages 80 years and older have been lower than the general population.
Researchers analyzed the health records of nearly 6 million patients admitted to U.S. hospitals between 2000 and 2010. This included patients with an ischemic stroke diagnosis, who received tPA.
Study participants were 35 percent 80 years and older, 37 percent 65 to 79 years of age, and 28 percent were 18 to 64.
They found that tPA administration rate increases from 2000 to 2010 were:
- 0.47 to 3.55 percent for the oldest group studied;
- 0.92 to 3.87 percent for 65 to 79 year olds; and
- 1.02 to 3.61 percent in patients ages 18 to 64.
Among 80 year-old and older individuals:
- Those treated at an urban hospital and teaching hospital were more likely to receive tPA.
- Women, Blacks, Hispanics and Medicaid holders were less likely to receive tPA.
Ways to improve safe and effective tPA administration among very elderly stroke patients should be explored, researchers said.
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Michelle P. Lin, M.D., M.P.H., University of Southern California, Los Angeles, Calif.
Patients with “wake-up strokes” may be candidates for tPA treatment
Tissue plasminogen activator (tPA) appears to be safe in the treatment of stroke detected when people wake up in the morning, according to a multicenter, prospective study presented at the American Stroke Association’s International Stroke Conference 2015.
Many patients with these “wake-up strokes” are not candidates for tPA because the treatment is only approved to be delivered within a three-hour window of stroke onset or time when last seen normal.
Researchers administered tPA to 40 moderate severity wake-up stroke patients with a broad range of stroke severities and disabling deficits. Patients received tPA an average of 2.6 hours after waking up with stroke symptoms.
Among treated patients:
- None of the patients treated had the most feared side effect that can occur with tPA: intracerebral hemorrhage, resulting in neurological worsening.
- Fifty percent of the stroke patients made full recoveries after their strokes, when followed-up at 90 days.
Treatment with tPA seems to be safe in wake-up stroke patients and should be studied in a larger trial for effectiveness, researchers said.
Andrew D. Barreto, M.D., The University of Texas Health Science Center at Houston, TX.
Church-based health intervention may help parishioners reduce stroke risk
A church-based health intervention reduced stroke risk behaviors among Hispanic and non-Hispanic parishioners, according to research presented at the American Stroke Association’s International Stroke Conference 2015.
The Stroke Health and Risk Education (SHARE) Project was a faith-based, culturally-sensitive behavioral intervention study to reduce stroke risk factor behaviors such as physical inactivity, poor eating habits and uncontrolled high blood pressure. The one-year intervention included a physical activity guide with pedometer and educational materials on healthy eating and blood pressure management. It also included motivational counseling calls and a support workshop with peers.
Researchers applied the intervention to five of 10 Catholic churches in Corpus Christi, Texas. The other five served as a comparison group. Of the 760 Hispanic and non-Hispanic white Catholic parishioners who participated in the study:
- Those in the intervention group had an increase of 0.25 cups a day in fruit and vegetable intake compared to the control group.
- Intervention group participants decreased salt intake by 123 milligrams per day, compared to the control group.
- There was no difference between the groups in physical activity level improvement.
While more research is needed, SHARE’s success in improving stroke risk behaviors suggests that faith-based programs may be useful to reduce stroke in communities including Hispanic Americans, the nation’s largest minority population, researchers said.
Devin Brown, M.D., University of Michigan, Ann Arbor, Mich.
Ideal heart health not only impacts heart, but also future ability to function
Cardiovascular health impacts how well people function in the years to come, even if they’ve not had a stroke or heart attack, according to research at the American Stroke Association’s International Stroke Conference 2015.
Researchers studied more than 3,200 adults in Northern Manhattan, looking for indicators of “ideal cardiovascular health status” and measured functional ability using an index from zero to 20. Functional ability included activities of daily living such as feeding, bathing, grooming, dressing, bowel and bladder function, toilet use and mobility. Cardiovascular health includes seven risk factor metrics: smoking, blood pressure, blood glucose, body mass index, physical activity, diet and total cholesterol.
- Twenty percent had zero or one ideal metric; 32 percent had two; 30 percent had three; 14 percent had four; and 4 percent had five to seven ideal metrics.
- The higher the number of ideal metrics, the better the functional scores at five and ten years (even when the effect of strokes and heart attacks was removed).
- At 10 years, poor physical activity predicted a lower functional score by 3.48 points, and non-ideal fasting glucose level predicted a lower functional score by 4.58 points.
The ideal cardiovascular health metric is an excellent predictor of functional status. Achieving the American Heart Association’s 2020 goal to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent, might not only have favorable effects on stroke and heart attack, but also may reduce functional impairment, researchers said.
Mandip S. Dhamoon, M.D., M.P.H., Mount Sinai School of Medicine, N.Y., N.Y.
Smaller “stroke belt” among kids but picture still grim
Children living in a part of the Southeastern United States, known as the stroke belt, are no more likely to be hospitalized for stroke than children in non-stroke-belt states, researchers reported at the American Stroke Association’s International Stroke Conference 2015.
Adults in the stroke belt are more likely to be hospitalized for stroke and die from it than adults in other parts of the country. Prior research has also found children in stroke belt states have a higher rate of death from stroke than children elsewhere.
In the current study, researchers looked at whether children in these states are hospitalized more for ischemic stroke by analyzing national stroke hospital discharges for people 20 years or younger compared to adults between 2006 and 2009.
- While hospitalization rates were 32 percent to 52 percent higher for adults in the stroke belt, hospitalization rates for children with stroke were similar, at 1.2 per thousand in stroke belt states and 1.4 per thousand in non-stroke belt states. There was no difference in in-hospital mortality rates by region.
Because there was no difference in stroke hospitalizations or early mortality in children residing in the stroke belt, the results suggest that factors which manifest later in life are responsible for the increased risk of stroke related death among adults in the stroke belt.
Judith H. Lichtman, M.D., Ph.D., Yale School of Public Health, New Haven, Conn.