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Haptoglobin Hp2 Variant Promotes Premature Cardiovascular Death in Stroke Survivors.

https://arctichealth.org/en/permalink/ahliterature284104
Source
Stroke. 2017 Jun;48(6):1463-1469
Publication Type
Article
Date
Jun-2017
Author
Petra Ijäs
Susanna Melkas
Jani Saksi
Antti Jula
Matti Jauhiainen
Niku Oksala
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Perttu Lindsberg
Timo Erkinjuntti
Source
Stroke. 2017 Jun;48(6):1463-1469
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiovascular Diseases - genetics - mortality
Cross-Sectional Studies
Female
Finland - epidemiology
Follow-Up Studies
Genotype
Haptoglobins - genetics
Humans
Male
Middle Aged
Stroke - genetics - mortality
Survivors
Abstract
Haptoglobin (Hp) is an acute phase plasma protein protecting tissues from oxidative damage. It exists in 2 variant alleles (hp1/hp2) giving rise to 3 protein isoforms with different biochemical properties and efficiency to limit oxidative stress. We previously found that hp2 variant is associated with stroke risk in the patients with carotid stenosis and the risk of ischemic cardiovascular events in a general population cohort. This study examined the hypothesis that Hp genotype is associated with general cardiovascular risk in patients with stroke.
Hp was genotyped in SAM study (Helsinki Stroke Aging Memory, n=378). A total of 1426 individuals ascertained from a nationally representative cross-sectional health survey served as population controls.
Hp genotype frequencies were 15.6% (hp1-1), 44.2% (hp1-2), and 40.2% (hp2-2) in patients with stroke. During a mean of 7.5-year follow-up after first-ever stroke, hp2 carriers had a substantially higher rate of cardiac deaths (24.5% versus 8.5%; P=0.006) and a trend toward more fatal strokes (23.5% versus 13.6%; P=0.122). The combined risk of ischemic cardiovascular deaths was 2.4-fold higher among hp2 carriers (95% confidence interval, 1.28-4.43) after adjustment for major cardiovascular risk factors.
Hp2 allele is associated with premature ischemic cardiovascular deaths after first-ever ischemic stroke.
PubMed ID
28487337 View in PubMed
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Long-term mortality after first-ever and recurrent stroke in young adults.

https://arctichealth.org/en/permalink/ahliterature258792
Source
Stroke. 2014 Sep;45(9):2670-6
Publication Type
Article
Date
Sep-2014
Author
Karoliina Aarnio
Elena Haapaniemi
Susanna Melkas
Markku Kaste
Turgut Tatlisumak
Jukka Putaala
Source
Stroke. 2014 Sep;45(9):2670-6
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Female
Finland
Follow-Up Studies
Hemorrhage
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Recurrence
Stroke - diagnosis - mortality - physiopathology
Treatment Outcome
Young Adult
Abstract
Mortality after first-ever stroke, and particularly after recurrent stroke, and predictors of long-term mortality among young and middle-aged stroke patients are not well-known. We assessed 17-year risk of mortality with focus on the effect of recurrence on the risk of death of young and middle-aged patients with stroke.
Mortality and recurrent stroke rate of 970 consecutive 30-day survivors of first-ever ischemic stroke aged 15 to 49 years (1994-2007) were studied. Prospective follow-up data came from the Finnish Care Register for Health Care and Statistics Finland. Mean follow-up was 10.2±4.3 years. We compared survival between clinical subgroups and identified factors associated with mortality. Standardized mortality ratio was calculated for demographic and pathogenetic subgroups using mortality data of the general population matched with age, sex, calendar year, and geographical area.
At the end of follow-up, 152 (15.7%) patients had died (cumulative risk, 23.0%; 95% confidence interval, 19.1%-26.9%) and 132 (13.6%) had experienced a recurrent stroke. After adjusting for baseline characteristics, recurrent stroke was statistically the most important risk factor for mortality after first-ever ischemic stroke (hazard ratio, 16.68; 95% confidence interval, 2.33-119.56; P=0.005). Observed mortality was 7-fold higher than the expected mortality (standardized mortality ratio, 6.94; 95% confidence interval, 5.84-8.04) and particularly high among patients who experienced a recurrent stroke (standardized mortality ratio, 14.43; 95% confidence interval, 10.11-18.74).
The high mortality rates and the striking impact of recurrent stroke on the risk of death should lead to development of more robust primary and secondary prevention strategies for young patients with stroke.
PubMed ID
25061076 View in PubMed
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Post-stroke delirium in relation to dementia and long-term mortality.

https://arctichealth.org/en/permalink/ahliterature134607
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Publication Type
Article
Date
Apr-2012
Author
Susanna Melkas
Jouko V Laurila
Risto Vataja
Niku Oksala
Hanna Jokinen
Tarja Pohjasvaara
Antero Leppävuori
Markku Kaste
Pekka J Karhunen
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. susanna.melkas@hus.fi
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Delirium - epidemiology - etiology
Dementia - etiology
Educational Status
Female
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Risk factors
Stroke - complications - mortality
Abstract
Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.
The study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.
Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.
In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.
PubMed ID
21560162 View in PubMed
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Poststroke dementia is associated with recurrent ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature116255
Source
J Neurol Neurosurg Psychiatry. 2013 Jul;84(7):722-6
Publication Type
Article
Date
Jul-2013
Author
Gerli Sibolt
Sami Curtze
Susanna Melkas
Jukka Putaala
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Niku K J Oksala
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, P.O. Box 340 (Haartmaninkatu 4), , Helsinki 00029 HUS, Finland. gerli.sibolt@hus.fi
Source
J Neurol Neurosurg Psychiatry. 2013 Jul;84(7):722-6
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Ischemia - complications - epidemiology
Cardiovascular Diseases - complications - epidemiology
Cognition Disorders - etiology - psychology
Cohort Studies
Dementia - epidemiology - etiology
Diagnostic and Statistical Manual of Mental Disorders
Educational Status
Female
Finland - epidemiology
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Memory - physiology
Middle Aged
Neuroimaging
Neuropsychological Tests
Recurrence
Regression Analysis
Risk factors
Stroke - complications - epidemiology - etiology
Tomography, X-Ray Computed
Abstract
To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.
We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and  PSD on survival free of recurrent stroke were estimated using Kaplan-Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models.
In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p
PubMed ID
23418214 View in PubMed
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Severe cerebral white matter lesions in ischemic stroke patients are associated with less time spent at home and early institutionalization.

https://arctichealth.org/en/permalink/ahliterature277043
Source
Int J Stroke. 2015 Dec;10(8):1192-6
Publication Type
Article
Date
Dec-2015
Author
Gerli Sibolt
Sami Curtze
Susanna Melkas
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Niku K J Oksala
Timo Erkinjuntti
Source
Int J Stroke. 2015 Dec;10(8):1192-6
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain - pathology
Brain Ischemia - epidemiology - pathology - therapy
Female
Finland - epidemiology
Follow-Up Studies
Hospitals, University
Humans
Institutionalization - statistics & numerical data
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Registries
Severity of Illness Index
Stroke - epidemiology - pathology - therapy
Time
White Matter - pathology
Abstract
Cerebral white matter lesions are one imaging surrogate for cerebral small vessel disease. These white matter lesions are associated with increased morbidity and mortality in both the general population and ischemic stroke patients.
To investigate whether severe white matter lesions in a cohort of ischemic stroke patients are associated with fewer days spent at home and earlier permanent institutionalization.
We included 391 consecutive patients aged 55-85 years with ischemic stroke admitted to the Helsinki University Central Hospital (the Stroke Aging Memory cohort) with a 21-year follow-up. Hospitalization and nursing home admissions were reviewed from national registers.white matter lesions were rated using magnetic resonance imaging performed three-months poststroke, dichotomized as none-to-moderate and severe. Kaplan-Meier plots log-rank and binary logistic regression (odds ratio) and Cox multivariable proportional hazards model were used to study the association of white matter lesions with days spent at home and the time of permanent institutionalization. Hazards and odds ratio with their 95% confidence intervals are reported.
Severe white matter lesions were associated with fewer days spent at home, and more frequent, and earlier permanent institutionalization (1487 vs. 2354 days; log-rank P?
PubMed ID
26487377 View in PubMed
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White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage.

https://arctichealth.org/en/permalink/ahliterature267182
Source
Stroke. 2015 Aug;46(8):2149-55
Publication Type
Article
Date
Aug-2015
Author
Sami Curtze
Elena Haapaniemi
Susanna Melkas
Satu Mustanoja
Jukka Putaala
Tiina Sairanen
Gerli Sibolt
Marjaana Tiainen
Turgut Tatlisumak
Daniel Strbian
Source
Stroke. 2015 Aug;46(8):2149-55
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Administration, Intravenous - adverse effects
Aged
Cerebral Hemorrhage - diagnosis - epidemiology - etiology
Cohort Studies
Female
Finland - epidemiology
Humans
Male
Middle Aged
Retrospective Studies
Risk factors
Thrombolytic Therapy - adverse effects
White Matter - pathology
Abstract
Cerebral white matter lesions (WMLs), a surrogate for small-vessel disease, are common in patients with stroke and may be related to an increased intracranial bleeding risk after intravenous thrombolysis in acute ischemic stroke. We aimed to investigate the risk of symptomatic intracerebral hemorrhage (sICH) in the presence of WMLs in a large cohort of ischemic stroke patients treated with intravenous thrombolysis.
We included 2485 consecutive patients treated with intravenous thrombolysis at the Helsinki University Central Hospital. WMLs were scored according to 4 previously published computed tomography visual rating scales from all baseline head scans. A sICH was classified according to the European Cooperative Acute Stroke Study II criteria. The associations of sICH with nominal, ordinal, and continuous variables were analyzed in a univariate binary regression model and adjusted in multivariate binary regression models.
In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables or dichotomized at different cutoff points) were associated with increased risk of sICH. In binary analyses, WML doubled the bleeding risk: the odds ratios of all 4 visual rating scales ranged from 2.22 (95% confidence interval, 1.49-3.30) to 2.70 (1.87-3.90) in univariable and from 2.00 (1.26-3.16) to 2.62 (1.71-4.02) in multivariable analyses. The multivariable-adjusted odds ratio for the association of high load of WMLs with remote parenchymal hemorrhage was 4.11 (2.38-7.10).
WMLs visible on computed tomography are associated with a more than doubled risk of sICH in patients treated with intravenous thrombolysis for acute ischemic stroke.
PubMed ID
26111888 View in PubMed
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6 records – page 1 of 1.