Tag: American Heart Association

Categories : Cardiovascular DiseaseTags :

Maintaining Heart Health may Reduce Cerebral Small Vessel Disease

On By ModernMedia
Photo by Ketut Subiyanto on Pexels

Maintaining excellent cardiovascular health may lower the risk for abnormalities in the small vessels of the brain, a new study suggests.

Scientists aren’t sure what causes the condition, known as cerebral small vessel disease, or CSVD. Previous research shows CSVD contributes to about half of dementia cases, a quarter of clot-caused strokes and most bleeding strokes.

For the new study, researchers looked at data from 3067 older adults in Lishui, China. The study team ranked each person’s cardiovascular health as “poor,” “intermediate” or “ideal” based on three medical factors (blood pressure, cholesterol and blood sugar) and four modifiable behaviours (not smoking, maintaining a healthy weight, eating healthy and being physically active).

Next, they compared cardiovascular health to brain MRI scans that looked for signs of CSVD, such as cerebral microbleeds – remnants of blood that has leaked out of small vessels – and lesions called white matter hyperintensities.

The study found participants with ideal cardiovascular health had 26% lower odds of having CSVD than those with poor cardiovascular health. The research was published Wednesday in the journal Stroke.

“The findings were somewhat expected, since a healthy lifestyle can benefit both the arteries and the brain,” said study co-author Yuesong Pan, a researcher of neurological diseases at Capital Medical University’s Beijing Tiantan Hospital in China.

“This suggests that in clinical practice, the target is to attain an ideal (cardiovascular health) score, not just an intermediate score,” he said. “Patients can use a simple self-measuring scale to adjust their lifestyle, assess the risk of CSVD and reduce their CSVD burden.”

Researchers used the American Heart Association’s tool for scoring cardiovascular health that was recently updated to add sleep duration as an eighth factor for ideal heart and brain health. Pan suggested people use the tool, now known as Life’s Essential 8, to find out their risk for cardiovascular disease.

Dr. José Rafael Romero, a neurologist who wasn’t involved in the research, said CSVD is important because “it does not have a specific treatment and it is such a strong contributor to stroke and dementia, which are epidemic conditions around the world.”

In 2020, 7.1 million people worldwide died of stroke, according to AHA statistics. In the US, stroke ranks fifth among all causes of death, with more than 160 000 deaths in 2020, based on data from the Centers for Disease Control and Prevention.

Alzheimer’s disease – the main cause of dementia – is the seventh-leading cause of death in the US. An estimated 6.5 million people age 65 and older have the condition, according to the Alzheimer’s Association. That number is expected to reach 12.7 million by 2050.

“The study is important because it gives additional information on how to lower CSVD risk, which may have an enormous public health benefit,” said Romero, an associate professor of neurology at Boston University School of Medicine who wrote an editorial published alongside the new research.

“It shows that we shouldn’t stop halfway. We should aim for achieving all the goals and achieving ideal cardiovascular health.”

Pan said the study was limited by incomplete dietary data and because it didn’t follow participants over a period of time. He called for larger, long-term observational studies to learn more about the relationship between CSVD and cardiovascular disease risk factors.

Romero said randomised clinical studies are needed to see whether controlling cardiovascular disease risk does indeed lower small vessel disease risk. He also called for future studies to evaluate the usefulness of screening high-risk people for CSVD using brain MRI.

In general, he said, health care professionals and health organisations need to come up with a clearer plan on how to fight CSVD.

“Often, there is no dedicated effort to control risk factors and track this consistently, particularly in patients that have high risk,” Romero said. “We really need to develop programs for effective and sustained implementation of these guidelines for preventing cardiovascular disease.”

Source: American Heart Association

Categories : Cardiovascular DiseaseTags :

In Severe Stroke, Mechanical Clot Removal Leads to Improved Outcomes

On By ModernMedia
A clot within a blood vessel interrupting blood flow to the brain.
Copyright American Heart Association

Ischaemic stroke patients previously considered unlikely to survive without severe disability may regain far more function if the blood clots are mechanically removed in addition to standard medical therapy, according to preliminary late-breaking research presented today at the American Stroke Association’s International Stroke Conference 2022.

In 2018, the American Heart Association’s stroke treatment guidelines were updated to recommend endovascular therapy (mechanical clot removal) for select stroke patients to improve the odds of functional recovery. This new study in Japan is the first randomised, controlled trial to demonstrate the effectiveness of endovascular therapy in patients with severe strokes involving clots in one or more large brain arteries, causing a large blood flow interruption in the brain. This approach had worked for patients with fewer areas of the brain disrupted, however, clinical experience was mixed for patients with more severe strokes.

Infarction area, or core area, estimates the volume of brain affected and describes the blockage location as seen on a brain CT. A lower number translates to a stroke affecting more core areas of the brain: 8-10=small core, 6-7=moderate core and 0-5=large core. Current US stroke guidelines recommend endovascular therapy for core areas 6-9. This study examined blockages that scored as 3-5. Strokes with blockages measuring 0-2 core areas are considered too severe and highly unlikely the patient would return to ambulatory independence.

“I have often encountered a dramatic improvement in a patient just after the mechanical clot removal procedure, even when the infarction area was large. Yet, patients sometimes also experienced severe haemorrhagic transformation [a life-threatening complication that occurs when blood from outside the brain crosses the blood-brain barrier and worsens stroke outcome] after the artery was reopened. So, in Japan, our stroke physicians are always cautious about endovascular therapy when the infarction area is large,” said Professor Shinichi Yoshimura, lead author of the study.

This randomised study included 203 stroke patients (average age of 76 years; 44% women). Most (71%) were examined and had MRI or a CT scan of the brain within 6 hours after stroke symptoms were first noticed, when patients are generally considered eligible for endovascular therapy. The other patients were seen between 6-24 hours after symptoms were noticed, and additional imaging showed areas of the brain that might benefit from prompt treatment.

On imaging, all patients were found to have clots blocking a large cerebral artery – either the internal carotid artery, the proximal middle cerebral artery or both. The strokes were rated as severe (median 22 on the National Institutes of Health (NIH) Stroke Scale,) and involved disrupted blood flow to large areas of the brain (about 7 out of 10 regions).

After imaging, the patients were randomly selected to receive either standard medical care for stroke (intravenous fluids, controlling blood pressure and other risk factors, and thrombolytics for lower bleeding risk patients) or standard medical care plus endovascular therapy performed within an hour after imaging to mechanically remove the clots. Due to bleeding concerns, intravenous thrombolytics were sparingly administered to select patients in a similar proportion in both treatment groups (27 of those who received endovascular therapy and 29 who received standard care).

Comparing the 100 patients who received endovascular therapy with 102 on standard therapy alone, the analysis found:

  • Patients who received endovascular therapy were 2.43 times more likely (31% vs 13%) to be able to walk unassisted and to have a residual disability rated as none to moderate 90 days later.
  • After 90 days, more of the patients (14% vs. 6.9%) who received endovascular therapy were considered functionally independent, meaning they were either able to carry out all their pre-stroke activities or to have a slight disability that did not require daily assistance.
  • At 48 hours after treatment, more of the patients (31% vs. 8.8%) who received endovascular therapy had major early neurological improvement.

“Our findings confirm that anyone who suffers from stroke should be transferred to a medical facility capable of endovascular therapy as soon as possible. The benefit of endovascular therapy is not limited by the severity or region of a stroke. These patients may have the chance to more fully recover from stroke and go back to their previous lives and activity levels,” said Professor Takeshi Morimoto, senior author of the study.

Several outcomes were compared to evaluate the safety of adding endovascular therapy to medical treatment, with researchers reporting:

  • Within 48 hours, scans revealed that more of the patients who received endovascular therapy had experienced some bleeding within the brain (with or without symptoms), 58% vs. 31%, respectively.
  • However, the number of patients who experienced other adverse outcomes was similar in the two treatment groups. The adverse events included brain bleeding within 48 hours that caused a worsening of neurological status (4 points or greater worsening on the NIH Stroke Scale); the need for surgery to relieve pressure on the brain in the first week; death within 90 days; or the recurrence of ischaemic stroke within 90 days.

“The finding of more intracranial bleeding in the patients who received endovascular therapy is very important. However, there were haemorrhages with symptoms and some that caused no symptoms. The haemorrhages with no symptoms were detected on imaging conducted for this study in the endovascular treatment group, not in the standard practice group. Symptomatic intracranial haemorrhage still occurred more commonly among patients in the endovascular group, however, it was not a statistically significant difference from the standard care group,” Morimoto said.

Due to different treatment protocols in Japan, where there is less use of intravenous thrombolysis than in the US and other western countries, and where more strokes are imaged with MRI than CT, this study’s results may over- or underestimate the effectiveness of endovascular therapy.

The researchers are currently performing sub-analyses to help identify factors that might signal which patients are more likely to have a greater return of function after the treatment. “In addition, tools, devices or rehabilitation methods that could potentially improve the likelihood for similar patients to recover with less disability should be investigated,” Morimoto said.

Source: American Heart Association

Categories : Cardiovascular DiseaseTags :

American Heart Association’s In-hospital Stroke Evaluation and Treatment Recommendations

On By ModernMedia
Image copyright American Heart Association

Despite the fact that hospitalised patients are in a monitored environment, stroke evaluation and treatment are often delayed compared to patients arriving with a stroke at the emergency department, contributing to higher rates of morbidity and mortality for in-hospital stroke. 

This is according to an American Heart Association scientific statement published in Stroke. This scientific statement was discussed at the Association’s International Stroke Conference in New Orleans. An American Heart Association scientific statement is an expert analysis of current research and may inform future clinical practice guidelines. This follows on from a previous 2019 update on recommendations systems of care to improve patient outcomes in stroke.

The statement outlines five elements for the development of hospital systems of care and targeted quality improvement to reduce delays and optimise treatment to improve outcomes for patients who experience an in-hospital stroke. In-hospital stroke is a stroke that occurs during a hospitalisation for another diagnosis and affects between 35 000 and 75 000 hospitalised patients annually in the United States.

The five core elements of the statement are:

  • training all hospital staff on stroke signs, symptoms and activation protocols for in-hospital stroke alerts;
  • creating rapid response teams with dedicated stroke training and immediate access to neurologic expertise;
  • standardising the evaluation of potential in-hospital stroke patients with physical assessment and imaging;
  • eliminating and addressing potential treatment barriers including interfacility transfer to advanced stroke treatment; and
  • establishing an in-hospital stroke quality oversight program delivering data-driven performance feedback and driving targeted quality improvement efforts.

The statement encourages institutions to develop a plan for in-patient stroke response teams that includes education, quality review and specified oversight.

The statement was developed by the writing committee on behalf of the American Heart Association’s Stroke Council; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiovascular and Stroke Nursing; the Council on Clinical Cardiology; and the Council on Lifestyle and Cardiometabolic Health. The diverse committee included experts in nursing, neurology, internal medicine, neurocritical care, neurosurgery and neurointerventional radiology. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Cerebrovascular Section affirms the educational benefit of this statement.

American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic, and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Source: American Heart Association