Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Stroke, Volume 53, Issue Suppl_1, Page A53-A53, February 1, 2022. COVID-19 pandemic has affected our health and economy. Clinical trials confirmed multiple neurological symptoms due to COVID-19, ranging from headaches, insomnia to stroke, and encephalopathy. More studies are required to unravel the cellular and molecular mechanisms to find a cure for these neurological symptoms. Here, we investigate the effect of COVID-19 spike protein (S-protein) on the cerebrovasculature and cognitive functions in two mouse models that express humanized ACE-2 (h ACE2), a receptor essential for cellular infection and COVID-19 internalization. We hypothesize that COVID-19 S-protein causes cognitive dysfunction via the deterioration of cerebrovascular functions.Methods:S-protein was either injected intravenously or directly into the hippocampus of K-18 (h ACE2 in epithelial cells) or global h-ACE2 knock-in (h ACE2 KI) mice or wild-type mice. Cognitive functions were assessed by Y-maze and Barnes maze. Cerebrovascular density was determined using confocal 3-D image reconstruction. Human brain microvascular endothelial cells (HBMVEC) were treated with S-protein and assessed for apoptosis and inflammatory markers using immunoblotting and RT-PCR. K-18 and h-ACE2 KI mice received intraocular injections of S-protein; retinas were evaluated for vascular cell death and inflammation.Results:S-protein injections caused significant deterioration in memory and learning function of K-18 and h-ACE2 KI mice but not in the wild-type mice (P

Stroke, Volume 53, Issue Suppl_1, Page ATMP13-ATMP13, February 1, 2022. Introduction:Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of stroke and worse stroke outcomes. A clinical score that can identify high-risk patients could enable closer monitoring and targeted preventative strategies.Methods:We used data from the AHA’s COVID-19 CVD Registry to create a clinical score to predict the risk of stroke among patients hospitalized with COVID-19. We included patients aged >18 years who were hospitalized with COVID-19 at 122 centers from March 2020-March 2021. To build our score, we used demographics, preexisting comorbidities, home medications, and vital sign and lab values at admission. The outcome was a cerebrovascular event, defined as any ischemic or hemorrhagic stroke, TIA, or cerebral vein thrombosis. We used two separate analytical approaches to build the score. First, we used Cox regression with cross validation techniques to identify factors associated with the outcome in both univariable (p

Stroke, Volume 53, Issue Suppl_1, Page ATMP23-ATMP23, February 1, 2022. Background and Purpose:We sought to investigate the impact of COVID-19 pandemic on number of acute stroke patients admitted to Japanese primary stroke centers (PSCs).Methods:The Japan Stroke Society and the MHLW registry of mechanical thrombectomy for acute ischemic stroke conducted a national annual survey of hospitalization volumes for acute ischemic stroke, intracranial cerebral hemorrhage, and subarachnoid hemorrhage in PSCs. Number of acute stroke patients was defined as sum of three stroke subtypes admitted within 7 days after the onset. Monthly acute stroke volumes were compared between 2019 and 2020, among COVID-19 waves, and regional infectious rates.Results:The stroke volume data was completed in 530 PSCs. The annual acute stroke volume was declined 2.5% from 179,893 in 2019 to 174,385 in 2020. Number of acute stoke patients was declined during COVID-19 expanding periods (1stwave, Mar-May; 2ndwave Jul-Aug; 3rdwave Nov-Dec), whereas it was increased in the other months. The mean decline rate of stroke volumes from 2019 to 2020 was greater in 125 PSCs located in prefectures with high estimated SARS-CoV 2 infected rate (more than 2,300 per million people) than in 405 PSCs of the other regions (-4.6±15.4% vs -0.1±20.0%, P=0.008), especially during COVID-19 expanding periods (-8.2±17.9% vs -3.1±21.3%, P=0.009).Conclusions:Acute stroke volumes were declined in 2020 from 2019 in Japanese PSCs, especially during COVID-19 expanding periods and in highly infected regions. The overwhelmed health care system and infection control practices may have associated with decline of number of acute stroke patients during COVID-19 pandemic.

Stroke, Volume 53, Issue Suppl_1, Page A153-A153, February 1, 2022. Introduction:Posterior reversible encephalopathy syndrome (PRES) can cause brain infarction and hemorrhage in the acute phase. We hypothesized that PRES is also associated with an increased long-term risk of stroke.Methods:We performed a retrospective cohort study using statewide all-payer claims data from 2016-2018 for all admissions to nonfederal hospitals in 11 states. Adult patients with PRES were compared to patients with TIA (positive control) and renal colic (negative control), as done in prior studies. The primary outcome was any stroke, and secondary outcomes were ischemic and hemorrhagic stroke. Diagnoses were ascertained usingICD-10-CMcodes. We excluded patients with stroke before and during index admissions for PRES and controls. We used Cox proportional hazards analyses to evaluate associations between PRES and stroke, adjusting for demographics, stroke risk factors, and factors associated with PRES (cancer, kidney disease, rheumatological disease). In a sensitivity analysis, stroke events within 4 weeks of index admissions were excluded.Results:We identified 3,086 patients with PRES, 85,189 with TIA, and 3,094 with renal colic. Patients with PRES (55±17 years) and renal colic (54±18 years) were younger than those with TIA (72±14 years). Median follow-up was 1.1 years and similar between groups. Stroke incidence was 3.2 per 100 person-years after PRES, 3.8 per 100 person-years after TIA, and 0.4 per 100 person-years after renal colic (Figure). After adjustment, patients with PRES had a similar stroke risk as patients with TIA (HR, 0.9; 95% CI, 0.8-1.2), and a higher stroke risk than patients with renal colic (HR, 2.6; 95% CI, 2.0-3.5). Compared to TIA, PRES had a higher risk of hemorrhagic stroke (HR, 2.9; 95% CI, 2.2-3.9) and a lower risk of ischemic stroke (HR, 0.7; 95% CI, 0.6-0.9). Results were similar with a 4-week washout period.Conclusions:PRES is associated with an increased risk of future stroke, specifically hemorrhagic stroke.

Stroke, Volume 53, Issue Suppl_1, Page ATMP20-ATMP20, February 1, 2022. Background:Neurologic complications of Coronavirus Disease 2019 (COVID-19) may be associated with neurotropism of the virus or secondary brain injury from systemic inflammation. Acute respiratory distress syndrome (ARDS) is associated with cerebrovascular injury, including both ischemia and hemorrhage. We aimed to compare brain MRI findings of COVID-19 associated ARDS with non-COVID-19 ARDS.Methods:A registry of patients with COVID-19 from March 2020 through July 2021 from a hospital network was reviewed. Patients who met criteria for ARDS by Berlin definition and underwent MRI during their hospitalization were included. These patients were matched 1:1 by age and sex with patients who underwent MRI from another registry of patients of ARDS in the same hospital between 2010 and 2018. Cerebrovascular injury was classified as either acute cerebral ischemia (ischemic infarct or hypoxic ischemic brain injury) or intracranial hemorrhage (ICH) including intraparenchymal hemorrhage, subarachnoid hemorrhage, subdural hematoma, and cerebral microbleeds (CMBs).Results:Of 13,319 patients with COVID-19 infection, 26 patients had ARDS and MRI. Sixty-six of 678 non-COVID-19 ARDS patients had an MRI and were matched 1:1 by age and sex resulting in 23 matched pairs. The median age was 66 and 59% of patients were male. Patients with COVID-19 ARDS were more likely to have hypertension and chronic kidney disease but otherwise baseline medical characteristics were similar. ARDS severity as determined by PaO2/FiO2 ratio at ICU admission was similar between both groups. No difference was seen in the prevalence of cerebrovascular injury (52% vs 61%, p=0.8), cerebral ischemia (35% vs 43%, p=0.8), ICH (43% vs 48%, p=1.0), or CMBs (43% vs 39% p=1.0) on MRI between the COVID-19 and non-COVID-19 cohorts. However, two unique patterns of injury were seen only among COVID-19 patients: hemorrhagic leukoencephalitis (3 patients, 12%) and bilateral cerebral peduncular ischemia with microhemorrhage (2 patients, 8%).Conclusion:Cerebrovascular injury was common in both COVID-19 and non-COVID-19 ARDS without significant frequency difference. However, COVID-19 ARDS had unique neuroimaging patterns that may indicate distinct patterns of brain injury of COVID-19.

Stroke, Volume 53, Issue Suppl_1, Page A54-A54, February 1, 2022. Background:COVID-19, being a prothrombotic state, has been linked to ischemic infarcts. Pooled data on impact of COVID-related stroke on mortality are sparse. We conducted a meta-analysis to assess the risk of stroke-related inpatient mortality (SRIM) during the COVID pandemic vs. pre-pandemic.Methods:Pubmed/Medline, SCOPUS & EMBASE were searched for articles till August 2021 reporting stroke and SRIM during COVID-19 pandemic vs. pre-pandemic. Random-effects model for odds ratio (OR), I2statistics for heterogeneity assessment and leave-one-out method for sensitivity analysis were employed.Results:A total of 31 studies with 455,073 stroke hospitalizations; 365253 pre-pandemic and 89820 pandemics (mean age 72 vs 70 yrs) were analyzed. With a comparable distribution of males, AF, and thrombolysis, the meta-analysis showed a nearly 40% higher risk of mortality during pandemic vs. pre-pandemic admissions (OR 1.42, 95%CI:1.06-1.92, p=0.018, I2=98.59). Further subgroup analysis showed a slightly higher risk of mortality in cohorts with mean age

Stroke, Volume 53, Issue Suppl_1, Page ATP25-ATP25, February 1, 2022. Hypothesis:Hospital presentation for acute stroke may have been delayed during COVID-19. We hypothesize that stroke patients with mild symptoms (NIHSS

Stroke, Volume 53, Issue Suppl_1, Page AWP202-AWP202, February 1, 2022. Introduction:Stroke is one of the leading causes of death worldwide. Our study aimed to investigate clinical variables that influence long-term mortality.Methods:A retrospective study was done in patients admitted with stroke to Columbia University Irving Medical Center – New York Presbyterian Hospital between 1990 and 2020 from whom data adjudication and long-term outcome were available at the time of analyses. Stroke was classified as cardioembolic, large vessel, small vessel and cryptogenic. We established 5 models which were progressively adjusted for cardiovascular risk factors and treatment modalities. Data was analyzed using cox proportional regression analysis to obtain hazard ratios (HR) with 95% confidence intervals (CI).Results:The study included 775 patients with a mean age of 67±16 years; 47% were men, 32% had diabetes, 39% had dyslipidemia and 22% had a history of atrial fibrillation (AF). On discharge, 84% received statin therapy. After 8.9±5.9 years (0-17 years) of follow-up, 257 (33.2%) of the initial cohort died. In univariate analysis, stroke due to AF was the only predictor of long-term mortality compared to other mechanisms (HR 1.9, 95% CI 1.5-2.3), but the effect size and statistical significance were progressively attenuated after adjusting for confounders (HR 1.2, 95% CI 0.9-1.6). In the fully adjusted model, statin therapy on discharge (HR 0.6, 95% CI 0.5-0.9) was associated with decreased long-term mortality whereas higher NIHSS score on admission, older age and a history of diabetes were associated with higher long-term mortality (Table 1).Conclusion:Comorbidities, and not stroke mechanismper se,are determinants of long-term mortality after stroke. Advanced age, diabetes mellitus, high NIHSS score are associated with higher long-term mortality whereas statin prescription upon discharge is associated with lower mortality. Post-stroke care strategies need to be targeted to reduce the risk of mortality in high-risk patients.

Stroke, Volume 53, Issue Suppl_1, Page ATMP3-ATMP3, February 1, 2022. Background:Prospective studies have established the safety and efficacy of the PipelineTMEmbolization Device (PED) for treatment of intracranial aneurysms (IA).Objective:To investigate long-term outcomes from the Pipeline Embolization Devices for the Treatment of Intracranial Aneurysms (PEDESTRIAN) Registry.Methods:The PEDESTRIAN registry data was retrospectively reviewed, which included patients (March 2006-July2019) with complex IAs treated with PED. The primary angiographic endpoint was complete occlusion and long-term stability. Clinical and radiological follow-up was performed at 3-6 months, 12 months, and yearly thereafter.Results:A total of 835 patients (mean age 55.9±14.7 years; 80.0% female) with 1,000 aneurysms were included. Aneurysms varied in size: 64.6% were small (≤10mm), 25.6% were large (11-24mm), and 9.8% were giant (≥25mm). A total of 1,214 PEDs were deployed. Follow-up angiography was available for 85.1% of patients with 776 aneurysms at 24.6±25.0 months (mean). Complete occlusion was demonstrated in 75.8% of aneurysms at 12-months, 92.9% at 2-4 years, and 96.4% at >5 years. During the post-procedural period, mRS remained stable or improved in 96.2% of patients, with stability or improvement in 99.1% of patients >5 years. The overall major morbidity and neurological mortality rate was 5.8%. At multivariate analysis, age (HR 1.04; 95% CI 1.01-1.07, p=0.002) and non-saccular morphology (HR 2.91; 95% CI 1.06-7.97, p=0.038) were identified as independent predictors of mRs worsening. We found a trend towards lower rates of thromboembolic complications since the implementation of prasugrel, with 26 (4.4%) patients on clopidogrel developing stroke compared with 4 (1.6%) patients on prasugrel (OR 2.74; 95% CI 0.95-7.95, p=0.06). Trend towards less thromboembolic complications with PED Shield N= 3/213 (1,4%) OR 0.38 (95% CI o.12; 1.27), p value=0.11Conclusion:This study demonstrated high rates of long-term complete aneurysm occlusion, stable or improved functional outcomes, and low rates of complications and mortality. Clinical and angiographic outcomes improved over long-term follow-up, demonstrating endovascular treatment of IA with PED is safe and effective.

Stroke, Volume 53, Issue Suppl_1, Page ATMP21-ATMP21, February 1, 2022. Background:Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities.Methods:We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19); we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients.Results:Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2).Conclusion:Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.

Stroke, Volume 53, Issue Suppl_1, Page ATP91-ATP91, February 1, 2022. There is limited information on long-term risk of acute medical events after acute ischemic stroke (AIS) treatment with tissue plasminogen activator (tPA) or mechanical thrombectomy (MT). We sought to determine the incidence of seven acute medical events at 1 and 5 years after AIS treatment using an administrative database. The Optum Clinformatics Data Mart database was used to construct the cohort of patients aged 30+ years with AIS diagnosis (ICD-10 I63 or ICD-9 433.x1, 434.x1, 436 or DRG 061-063) during the period: 01/01/2015-06/30/2020 with at least 1-year observation prior to cohort entry. Using procedure coding (CPT or ICD-9/10), patients were grouped as tPA only, MT only, tPA+MT, or untreated. Excluded were patients with an acute event in year preceding first AIS treatment, or first AIS diagnosis for untreated patients. Acute medical events were assessed at 1 and 5 years. The denominator was calculated as the person-years (PY) (per 100) from AIS diagnosis date or treatment, until event occurrence date or database end. The Charlson-comorbidity score (CCS) was used to measure concomitant illness severity.The 313,756-patient AIS cohort was mostly male, had a mean age of 72 years, with 8% receiving intervention. In the first year, cardiovascular event rates were highest in the tPA+MT group for recurrent AIS (10.9/100 PY), myocardial infarction (4.8/100 PY), and venous thromboembolism (4.3/100 PY). All-cause mortality (35.2/100 PY) and urinary tract infections (31.4/100 PY) were highest in the tPA+MT group. The tPA group had the highest rate for pneumonia (18.6/100 PY). The untreated group had the lowest rate for all events. All event rates decreased at 5 years, with the largest decline (-34%) in recurrent AIS.Stroke patients remain at significant risk of morbidity in the first year after stroke, in spite of treatment, but rates of acute medical events decrease over time possibly related to prevention strategies.

Stroke, Volume 53, Issue Suppl_1, Page ATMP16-ATMP16, February 1, 2022. Introduction:Findings of association between COVID-19 and stroke remain inconsistent, ranging from significant association, absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The present study examined the association between COVID-19 and risk of acute ischemic stroke (AIS).Methods:We included 19,553 Medicare fee-for-service (FFS) beneficiaries aged ≥65 years diagnosed with COVID-19 between April 1 and November 30, 2020 and AIS hospitalization from January 1, 2019 through November 30, 2020. We used a self-controlled case series design to examine the association between COVID-19 and AIS and estimated the incident rate ratios (IRR) by comparing incidence of AIS in risk periods (0-3, 4-7, 8-14, 15-28 days after diagnosis of COVID-19) vs. control periods.Results:Among 19,553 Medicare FFS beneficiaries with COVID-19 and AIS, the median age at diagnosis of COVID-19 was 80.5 (interquartile range 73.6-87.3) years and 57.5% were women. IRRs at 0-3, 4-7, 8-14, and 15-28 days following COVID-19 diagnosis were 10.97 (95% confidence interval 10.30-11.68), 1.59 (1.35-1.87), 1.23 (1.07-1.41), and 1.06 (0.95-1.18), respectively. The association appeared to be stronger among younger beneficiaries and among beneficiaries without prior history of stroke but largely consistent across sex and race/ethnicities.Conclusions:Risk of AIS among Medicare FFS beneficiaries was ten times as high during the first 3 days after diagnosis of COVID-19 as during the control period and the risk associated with COVID-19 appeared to be stronger among those aged 65-74 years and those without prior history of stroke.

Stroke, Volume 53, Issue Suppl_1, Page ATMP103-ATMP103, February 1, 2022. Background:Measurement of allostatic load, quantified by the allostatic load index (ALI), is often utilized to evaluate the physiologic response to stress. Our objective was to assess whether allostatic load is associated with mortality after stroke or with stroke-specific mortality in the general population.Methods:Using data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File (National Death Index), we selected adults aged ≥ 25 years. Stroke was self-reported. We computed the weighted prevalence of each allostatic load index (ALI) category to obtain nationally representative estimates with higher ALI corresponding to higher stress burden. We evaluated the relationship between ALI category and mortality outcomes using the Cox proportional hazard model considering the survey design variables, adjusting for age, sex, education, marital status, and income.Results:Of 15,567 individuals included in the study, there were 48.3% ALI ≤ 1, 21.7% ALI = 2, and 30% ALI ≥ 3. Of 414 individuals with reported history of stroke there were 11.8% ALI ≤ 1, 22.1% ALI = 2, and 66.1% ALI ≥3. Higher ALI correlated with male sex, older age, lower education, married or widowed status, and lower income. In the population with history of prior stroke, those with ALI ≥ 3 had 2.7 times higher all-cause mortality and 4.5 times higher cardiovascular mortality compared to those with ALI ≤ 1 (Table). In the general population, the ALI ≥ 3 group had 1.8 times higher adjusted stroke mortality.Discussion:Baseline higher allostatic load predicts greater all-cause and cardiovascular mortality risk in stroke survivors and greater stroke mortality risk in the general population. A global approach towards addressing the modifiable indicators in the ALI may improve survival in these populations.

Stroke, Volume 53, Issue Suppl_1, Page ATMP56-ATMP56, February 1, 2022. Objective:To compare metrics of acute care for ischemic stroke (IS) before and after the first cases of COVID-19 were diagnosed and major changes were made to the workflow.Methods:Data were prospectively collected as part of the institutional Stroke Database project. Patients with IS > 18 years admitted from January 2019 until March 2020 were considered to be part of the group treated in the “pre-COVID” era and those admitted from April 2020 until December 2020, in the “post-COVID” era. The primary outcome was the door-to-needle time in subjects treated with intravenous thrombolysis. Secondary outcomes were: rate of thrombolysis, rates of complications (pneumonia, urinary tract infection, deep venous thrombosis or pressure injury) and death during hospital admission. Patients’ characteristics, primary and secondary outcomes were compared with unpaired t-tests, Mann-Whitney or chi-square tests, according to the nature and distribution of the data.Results:Data from 932 patients with IS in the pre-COVID and 520, in the post-COVID group were prospectively collected. There were no significant differences in age (pre-COVID, 64.2±14.7 years; post-COVID, 63.3±15 years; p=0.296), gender (pre-COVID, 55.5% male; post-COVID, 55% male; p=0.862) or NIHSS scores (pre-COVID, median 5, range 0-38; post-COVID, median 6, range 0-36; p=0.346). Thrombolysis rates were 19.6% pre-COVID and15.7% post-COVID. All eligible subjects received thrombolysis. The increase in door-to-needle time in subjects treated with thrombolysis (pre-COVID, median 36 minutes; post-COVID, median 39 minutes) was statistically significant (p=0.048). Rates of complications in all ISs during admission increased significantly from 8.3% (pre-COVID) to 20.2% (post-COVID) (p

Stroke, Volume 53, Issue Suppl_1, Page ATP22-ATP22, February 1, 2022. Background:COVID-19 is thought to induce a pro-thrombotic state, which might increase stroke risk. The purpose of this project is to assess stroke severity, type and coagulation markers such as D-dimer, fibrinogen, and CRP in patients with acute ischemic stroke (AIS) and COVID-19, compared to a control group of AIS without COVID-19.Methods:We captured discharge diagnosis of all patients at our medical center with AIS and COVID based on their discharge ICD-10 coding between June 2020 and May 2021; and identified AIS without COVID matched for age, sex, race, and ethnicity. Group 1 was AIS with COVID-19, Group 2 matched (3:1) AIS without COVID-19. We compared baseline demographics, NIHSS, D-dimer, fibrinogen, CRP, presence of large vessel occlusion (LVO) in COVID-19 AIS vs non-COVID-19 AIS. We used a T test to compare parametric and Mann Whitney U for non-parametric values.Results:In total 23 (of 397 total AIS) patients were in Group 1; 69 in Group 2. D-dimer levels (mean) were 3237.3 in Group 1, and 2706.8 in Group 2 (NS), Fibrinogen 464.4 and 379.8 (NS), CRP 7.9 and 9.4 (NS). Median NIHSS was 21 versus 5 (p=0.003). LVO was present in 17 patients in Group 1 (73%) and 23 (33%) in Group 2 (NS). In total, only 5.8% (23 of 397) of all AIS in our data had Covid-19 infection.Conclusion:COVID in stroke was an infrequent finding in our sample (5.8%). Patients with COVID and stroke had higher initial stroke severity, but did not differ in coagulation values. Weather coagulation markers can help distinguish patients with COVID related stroke will require subsequent studies. We need additional data before treatment recommendations specific to stroke in COVID can be made.

Stroke, Volume 53, Issue Suppl_1, Page ATMP47-ATMP47, February 1, 2022. Background:Around 50 million people in the US have inadequate access to nutritious food. Food insecurity is linked with chronic conditions and worse overall health. Research has shown that living in a lower SES neighborhood is linked to increased post-stroke mortality, but little is known about the effect of food insecurity on mortality.Methods:This study used the National Health and Nutrition Examination Survey (NHANES) dataset 1999/2000-2013/2014 with linked mortality files through 2015. Participants included those ≥ 20 years with a complete survey, physical examination, and mortality information. Stroke was self-reported. Food security was characterized as food secure (full, marginal) or food insecure (low, very low). We evaluated the relationship between food insecurity and all-cause, cardiovascular (CV) and stroke mortality in the general and stroke population using Cox proportional hazards regression models, adjusting for sociodemographic factors and comorbidities.Results:From 1999 to 2014, 40,777 people participated in NHANES and 1,530 reported a history of stroke. Prevalence of food insecurity was 11.6% in the general population and 15.5% in the stroke subset. Among the general population, there were 5394 deaths due to all-causes, 1152 CV deaths, and 216 stroke deaths. Among the stroke population, there were 650 deaths due to all-causes, 176 CV deaths, and 41 stroke deaths. In the general population, food insecure individuals had higher adjusted all-cause mortality (aHR 1.15, CI 1.01-1.32) and a trend towards higher CV (aHR 1.14, 0.85-1.52) and stroke mortality (aHR 1.23, 0.65-2.34). In participants with prior stroke, food insecurity had no impact on all-cause, CV or stroke mortality.Discussion:Although prior studies have demonstrated that living in a low SES neighborhood results in worse post-stroke mortality, this data suggests the effect is not directly linked with food insecurity. A potential explanation is that individuals may receive greater access to food resources after a stroke. There is also the possibility that the low frequency of deaths among stroke survivors limited the ability to detect an effect. Further study is needed to explore the underpinnings of worse post-stroke outcomes in lower SES neighborhoods.