Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4124839-A4124839, November 12, 2024. Introduction:Thrombus in the left atrial appendage (LAA) is known to be one of the risk factors for ischemic stroke, and after the detection of LAA thrombus, anticoagulation therapy is usually administered. However, the role of anticoagulation therapy before the detection of LAA thrombus in the prognosis is still unclear.Hypothesis:We assessed the hypothesis that the anticoagulation status at the time of LAA thrombus detection with transesophageal echocardiography (TEE) affects the future incidence of ischemic stroke.Methods:Patients who underwent TEE and were found to have LAA thrombus were included. Patients were divided into two groups based on their anticoagulation status before TEE. To exclude strokes that might occur due to the detected LAA thrombus itself, landmark analysis was performed by excluding patients who had a stroke or died within 30 days after detection of the LAA thrombus. The difference in the 7-year cumulative incidence of ischemic stroke was assessed using the Gray-test. Fine-Gray proportional hazard regression was utilized to assess the impact of anticoagulation status on ischemic stroke.Results:Among 183 patients detected with LAA thrombus, 15 suffered ischemic stroke or death within 30 days of detection, and 168 patients were included in this study. Of these, 58 patients were treated with anticoagulation therapy before the index detection of LAA thrombus (PreAC group). Patients in the PreAC group were older (median 76 years [interquartile range 51-88 years] vs. 74 years [38-89 years], P = 0.032) than those in the non-PreAC group. The rates of CHA2DS2-VASc score ≥ 2 (93% vs. 89%, P = 0.582), male sex (64% vs. 70%, P = 0.488), and history of atrial fibrillation (98% vs. 95%, P = 0.667) were similar between the two groups. The cumulative ischemic stroke rate was higher in the PreAC group than in the non-PreAC group (P = 0.048, Figure). Even after adjusting for CHA2DS2-VASc score, anticoagulation therapy before detection of LAA thrombus was significantly associated with the cumulative incidence of ischemic stroke (P = 0.049).Conclusions:Anticoagulation status before the detection of LAA thrombus is a determinant of a higher incidence of ischemic stroke. The background mechanisms suggesting a tendency toward thrombus generation even when treated with anticoagulation are proposed.

Circulation, Volume 150, Issue Suppl_1, Page A4145081-A4145081, November 12, 2024. Background:The incidence of stroke in young adults is on the rise in the United States. Drug abuse has been proposed as a known modifiable risk factor for stroke in this age group. The association between cannabis use and stroke in young adults is an area that needs further exploration.Research Hypothesis:Cannabis is an independent modifiable risk factor for stroke in young adults with Cannabis Use Disorder(CUD).Aim:To investigate the association between Cannabis Use Disorder(CUD) and Stroke in young adults.Methods:Using the National Inpatient Sample 2019, admissions for stroke in the age group of 18-45 were identified. The cohort was subdivided into admissions with documented CUD. Demographic data of the cohort was analyzed, including the prevalence of comorbid conditions. Using multivariate binomial logistic regression, the association between cannabis use and the occurrence of stroke was studied, after accounting for age, smoking, cocaine abuse, and uncontrolled hypertension(HTN). A two-tailed p-value

Circulation, Volume 150, Issue Suppl_1, Page A4144108-A4144108, November 12, 2024. Background:The CHA2DS2-VASc risk score is a clinical tool for stroke prediction. It is mainly used in patients with atrial fibrillation (AF) but is also applied to the non-AF population. We previously reported that artificial intelligence (AI)-enabled left atrial (LA) volumetry from coronary artery calcium (CAC) scans (AI-CAC) predicts AF as early as one year and outperformed CHARGE-AF and NT-proBNP. In this report, we compare AI-CAC LA volumetry to the CHA2DS2-VASc risk score and evaluate the incremental value of incorporating AI-CAC LA volume to CHA2DS2-VASc for incident stroke prediction in the non-AF population.Methods:We applied the AutoChamberTMLA volumetry component of AI-CAC to CAC scans of 5830 people without AF (52.2% women, age 61.7±10.2 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) baseline (2000-2002). We used the 15-year outcomes data for incident stroke (ischemic and hemorrhagic) and assessed discrimination using the time-dependent area under the curve (AUC) between AI-CAC LA volume vs. CHA2DS2-VASc risk score. Notably, the CHA2DS2-VASc score in this non-AF population ranges from 0 to 5, whereas in the AF population it typically ranges from 0 to 9 points.Results:252 cases of stroke accrued over 15 years. The median and mean ± SD of CHA2DS2-VASc score at baseline were 1.0 and 1.58 ± 1.15, respectively. The cumulative incidence of stroke for the 95thpercentile of AI-CAC LA volume (n=291) vs. CHA2DS2-VASc 4 or 5 points (n=364) was 13.0% and 13.7%, respectively. AI-CAC LA volume significantly improved the AUC of CHA2DS2-VASc for stroke prediction at 2-year follow-up (0.76 for CHA2DS2-VASc vs. 0.81 for CHA2DS2-VASc plus LA volume, p=0.03), 5-year follow-up (0.73 vs. 0.77, p=0.01), 10-year follow-up (0.70 vs. 0.75, p

Circulation, Volume 150, Issue Suppl_1, Page ASa308-ASa308, November 12, 2024. Background:Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), an impedance threshold device (ITD) and controlled, gradual, automated head and thorax elevation, collectively termed automated Head Up Position (AHUP) CPR, increases cerebral perfusion pressure (CerPP), brain blood flow, coronary perfusion pressure (CorPP), end tidal CO2 (ETCO2) and cerebral oximetry (rSO2) in animal models when compared with conventional (C) CPR. AHUP-CPR in patients is associated with increased neurologically favorable survival versus C-CPR. This study tested the hypothesis that AHUP CPR will increase cardiac stroke volume (SV) and other hemodynamics compared with C-CPR in a porcine model of cardiac arrest.Methods:Farm pigs (n=15) were sedated, anesthetized, and ventilated. Hemodynamics, including intracardiac conductance catheter based biventricular (BiV) pressure-volume (PV) loops, were continuously measured and recorded. After 10 minutes of untreated ventricular fibrillation, C-CPR was performed for 2 minutes in the supine position using an automated CPR device designed for pigs at a rate of 100 compressions/minute, depth of 21% of the chest antero-postero diameter, a 50% duty cycle, and no active decompression. ACD+ITD was then performed with 3 cm of active decompression for 2 minutes, followed by AHUP-CPR, where the head and thorax were initially raised to 10 cm and 8 cm for a 2-minute priming phase, followed by elevation over the next 2 minutes to 24 cm and 9 cm. A linear mixed-effects model with a random intercept for individual pigs was used for statistical analysis.Results:CerPP, CorPP, ETCO2, and rSO2, as well as BiV SV and cardiac output, increased progressively and significantly with implementation of AHUP-CPR (p

Circulation, Volume 150, Issue Suppl_1, Page A4144421-A4144421, November 12, 2024. AbstractBackground:Stroke is a leading cause of death and disability worldwide and a significant burden on healthcare systems globally. Despite the effectiveness of tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke (IS), many patients arrive at the emergency department beyond the window to perform intravenous thrombolysis.Study objectives:This study investigated factors contributing to the delayed presentation of acute patients with stroke to emergency departments across governorate hospitals in Oman and assessed neurological function at 90 days using the Modified Rankin Scale.Methods:A prospective observational cohort multi-center study was conducted involving 512 participants with acute ischemic stroke symptoms who arrived at the emergency departments more than 4.5 hours after symptom onset. Data were collected using questionnaires administered to participants or their relatives to identify reasons for delayed arrival. Key variables included socio-demographic characteristics, symptom type, mode of arrival, and follow-up outcomes. Statistical analysis was performed to assess associations between these variables and participant outcomes.Results:The mean age of the participants was 61.96 years, with a majority being male (65.2%) and Omani nationals (81.3%). The most common symptoms were upper limb weakness (67.8%), lower limb weakness (60.4%), and inability to speak (56.7%). The primary mode of transfer to the hospital was by a relative (62.3%). Significant findings included; Delayed Arrival: Confusion, falls, and facial weakness were associated with the fastest median arrival times, while memory loss, loss of facial sensation, and abnormal eye movements were associated with the longest delays. Reasons for Delay: Common reasons for delay included lack of awareness of stroke symptoms (36.7%), believing symptoms would self-resolve (29.7%), and not knowing the importance of timely hospital arrival (31.9%). Outcomes: At 90 days, 36.3% had mild disability, 50.0% had moderate to severe disability, and 13.7% had died.Conclusion:Delayed hospital arrival in participants with stroke is influenced by various factors, including symptom type, mode of arrival, and socio-demographic characteristics. Enhancing public awareness about stroke symptoms and the importance of timely medical intervention could improve outcomes. This study provides valuable insights for improving stroke management and patient education in Oman.

Circulation, Volume 150, Issue Suppl_1, Page A4123899-A4123899, November 12, 2024. Aim:This study investigates the prevalence of isolated interventricular membranous septal (IVMS) aneurysms detected via echocardiography and assesses the associated stroke risk without other classical risk factors.Methods:We searched the echocardiography database at Mount Sinai Morningside from January 2017 to September 2023. Identified echocardiograms were reviewed to confirm IVMS aneurysms and exclude sinus of Valsalva aneurysms. Patients with concurrent structural heart anomalies were excluded. Medical records were examined for baseline characteristics, risk factors, and cortical brain infarcts.Results:From 51,732 subjects, 18 were identified with IVMS aneurysms, yielding a prevalence of 0.04%. Four patients with significant structural heart disease were excluded, resulting in a final sample size of 14. Of these, 9 (64%) were female with a mean age of 59.6, and 5 (36%) were male with a mean age of 55.4. The mean BMI was 27.9 kg/m2, with 4 classified as obese. All patients were nonsmokers; 2 had a family history of stroke. One patient had diabetes, 8 had hyperlipidemia, and 9 had hypertension. Only one patient had paroxysmal atrial fibrillation, with a CHA2DS2-VASc score of 0. Echocardiography revealed structurally normal hearts with a mean left ventricular ejection fraction of 61% and a mean left atrial volume index of 24.8 mL/m2. The mean neck diameter of the aneurysm was 8.7 mm, and the mean diameter was 11.9 mm. Two patients had inter-atrial septal aneurysms, and one had a patent foramen ovale.Out of the 14 patients, 5 had a history of ischemic stroke (4) or transient ischemic attacks (1), all of whom were 64 years or younger with a mean RoPE Score of 6 and a mean CHA2DS2-VASc score of 1.6 at the time of their first neurologic event. All patients were treated with aspirin and statin therapy. Two patients had recurrent strokes, one of whom had four recurrent strokes, all cortical infarcts. These patients were switched to clopidogrel after 3 months of dual antiplatelet therapy. No anticoagulation was used.Conclusion:This retrospective study highlights a notable association between isolated IVMS aneurysms and an increased risk of ischemic stroke (36%) and recurrent ischemic stroke (14%). Despite their rarity, these anomalies should be considered in unexplained strokes. Optimal management strategies remain ambiguous, but anticoagulation may be favored based on presumed stroke mechanisms. Large-scale multicenter studies are needed for validation.

Circulation, Volume 150, Issue Suppl_1, Page A4145048-A4145048, November 12, 2024. Introduction/ Background:Paroxysmal Atrial Fibrillation is a clinical condition that increases the risk for embolic stroke. Current guidelines suggest anticoagulating patients with atrial fibrillation when the chadvasc score is > 2 to decrease the risk of embolic stroke.Aim/ Research Questions:Analyze comorbid conditions that holds significant associations with occurence of embolic stroke in paroxsymal atrial fibrillation admissions while being on long term anticoagulation.Methods/Approach:We used National inpatient Sample (2019) to identify admissions for embolic pattern stroke, with documented history of Paroxysmal Atrial Fibrillation (p AFib) on chronic anticoagulation (AC) (Age group > 18 years).Prevalence of comorbid conditions in the cohort was analyzed. Associations of the comorbid conditions with occurrence of embolic stroke in the admission cohort was analyzed using multivariate linear regression. A two tailed p value < 0.05 was used to define significance in all the calculations.Results/Data:(descriptive and inferential statistics) Of 4780 admissions for embolic stroke with comorbid Pafib on chronic AC were identified. Mean age of the admission cohort was 76.94. Of the admissions, 38.192% had congestive heart failure, 25.83% had chronic kidney disease, 41.94% had uncontrolled hypertension, 54.18% had diagnosis of unspecified hyperlipidemia, 0.523% had Hypertrophic obstructive cardiomyopathy, 0.73% had rheumatic/non rheumatic mitral stenosis listed as their comorbidities. Statistically significant association was seen between uncontrolled hypertension and occurence of embolic stroke OR: 1.997. 95%: 1.756- 2.27. Documented diagnosis of unspecified hyperlipidemia had statistically significant association with admissions for embolic stroke in the patient cohort: OR: 1.642, 95% CI: 1.214 – 1.845). Presence of coexisting HOCM and Mitral stenosis had positive ODDs but did not reach statistical significance {HOCM: OR :1.50, 95% :0.062 - 3.63 and Mitral stenosis: OR: 1.59, 95%: 0.075- 3.36). (Table 1) There was no statistically significant association between CHF, CKD, smoking or with presence of prosthetic valve with embolic stroke.(HOCM: hypertrophic obstructive cardiomyopathy) (OR: Odds Ratio)Conclusion(s):Based on our analysis, presence of uncontrolled hypertension and hyperlipidemia had significant association with the occurrence of embolic stroke in paroxysmal atrial fibrillation population who were on long term anticoagulation.

Circulation, Volume 150, Issue Suppl_1, Page A4119428-A4119428, November 12, 2024. Background:Stroke remains a leading cause of mortality and disability. The narrow temporal window and limited availability of, and eligibility for thrombolytic therapy or endovascular thrombectomy are major therapeutic limitations in treating stroke. Neuroprotective therapies that could be given early to replace or augment these existing therapies are needed to improve stroke outcomes. We showed that monosialoganglioside (GM1) containing nanoliposomes composed of phosphatidylcholine, cholesterol and GM1 (70/25/5% molar ratios, NLGM1) protect against hypoxic injury likely through Nrf2-dependent upregulation of antoxidant enzymes.Aims:To test if post-occlusion NLGM1 treatment could reduce 1) acute stroke injury following middle cerebral artery occlusion (MCAO) and 2) chronic injury following photothrombotic (PT) stroke injury.Methods:20 week old C57BL/6 mice underwent MCAO for 60 minutes and then injected with saline or NLGM1 (1 or 2 mg IV) prior to reperfusion. Neurologic deficit score and brain infarct % area were measured the next day. Separately, mice underwent PT injury followed by injection of saline or NLGM1 (1 or 2 mg immediately and 2 hours post-injury) and cognitive/behavior tests done 1-90 days post injury.Results:Following MCAO, there was reduced neurologic impairment, infarct volume and brain edema with NLGM1 versus saline control (Fig. 1). Following PT injury, there was reduced neurologic, cognitive and motor impairment from Day 2-90 post-injury with NLGM1 versus saline control (Fig. 2). In both stroke models, there was no difference in efficacy between 1 and 2 mg NLGM1 doses.Conclusions:Treatment of mice with NLGM1 following MCAO or PT stroke injury resulted in improved structural (infarct size, edema) and functional (cognitive, behavior, motor) outcomes in the acute (MCAO) and chronic (PT) timeframes. NLGM1 is a potential novel therapeutic agent for stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4147578-A4147578, November 12, 2024. Introduction:Stroke is among the leading global health burdens worldwide due to the resultant morbidity and mortality. Accordingly, thorough evaluation of the temporal trends in stroke-related mortality in Canada is mandatory to effectively tackle the associated global and socioeconomic burden.Research Question:Are there temporal trends in stroke-related mortality in Canada during the last 3 decades?Aim:To evaluate the temporal trends in stroke-related mortality in Canada over the past 3 decades.Methods:Mortality trends of stroke in Canada have been evaluated by initially retrieving data from Global Burden of Diseases 2019 database. JoinPoint Analysis software was utilized to calculate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC).Results:There was a total of 1,269,854 stroke-related death reported during the period of 1990-2019. There is an overall decline in stroke-related death, with females displaying a higher decline in mortality from 1990 to 2019 with AAPC of -1.00 (95%CI: – 1.04 to -0.96; p

Circulation, Volume 150, Issue Suppl_1, Page A4146431-A4146431, November 12, 2024. The growing adoption of advanced imaging modalities, such as transesophageal echocardiography (TEE), has led to more frequent detection of cardiac structural abnormalities. While intracardiac cardiac tumors and shunts are infrequent and typically asymptomatic, their existence can precipitate severe outcomes, including stroke, myocardial infarction and sudden death.Case Description:A 69-year-old female presented with left sided facial droop, slurred speech and left arm weakness. A computed tomography angiography revealed focal occlusion of the distal right middle cerebral artery. She was initiated on thrombolytic therapy and experienced resolution of symptoms. Transthoracic echocardiogram revealed right to left shunting consistent with a patent foramen ovale (PFO). Further workup with TEE confirmed the presence of a PFO but also detected a mobile echogenic mass on the aortic valve leaflet, indicative of papillary fibroelastoma (PFE). Cerebral infarction was attributed to an embolic event, with the PFO and PFE being likely culprits.Discussion:Current guidelines give a conditional recommendation, low certainty of evidence, for PFO closure in adults older than 60 years, although some observational studies have shown some risk reduction in older patients. The key trials showing clinical benefit of PFO closure were in adults younger than the age of 60. For left sided cardiac tumors, such as PFE, guidelines give a 2A recommendation for resection. Addressing the risk for recurrent stroke in this 69-year-old patient was an essential part of stroke care, as such, a multi-disciplinary team of experts including cardiology, neurology, and cardiothoracic surgery was conveyed. The decision was to proceed with surgical intervention in addition to antiplatelet therapy to achieve optimal risk reduction. The patient subsequently underwent successful surgical removal of the PFE with native valve preservation and PFO closure.Conclusion:Cardiac PFEs and PFOs can be associated with increased stroke risk. Employing appropriate imaging techniques and timely interventions are of utmost importance in stroke management.

Circulation, Volume 150, Issue Suppl_1, Page A4144782-A4144782, November 12, 2024. Background:While dual antiplatelet therapy (DAPT) has been shown to significantly decrease recurrent stroke in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) of non-cardioembolic origin, it comes with a substantial increase in the risk of bleeding.Research Question:Do all patients with non-cardioembolic, mild ischemic stroke/high-risk TIA derive benefits from DAPT for secondary prevention?Aims:To identify patients who derive attenuated benefit from DAPT to avoid excessive bleeding risk.Methods:We searched 6 databases from inception to May 10, 2024 to identify randomized-controlled trials (RCTs) comparing short-term DAPT (up to 3 months) with aspirin for secondary prevention of non-cardioembolic ischemic stroke or TIA. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of any stroke, myocardial infarction, and cardiovascular (CV) death, with prespecified subgroups based on participants’ pre-stroke treatment with statins and antiplatelet agents. Secondary efficacy outcomes comprised of recurrent ischemic events and hemorrhagic stroke. Safety outcomes included major bleeding, CV mortality, and all-cause mortality. A random-effects meta-analysis was performed using restricted maximum likelihood method.Results:There were 5 RCTs including 27,559 patients. In the unselected population, DAPT significantly reduced MACCE (RR, 0.78; 95% CI, 0.71 to 0.85; I2= 0%; Figure 1A), compared to aspirin. However, patients with baseline statin (RR, 0.93; 95% CI, 0.73 to 1.17; I2= 0%; Figure 1A) or antiplatelet (RR, 0.91; 95% CI, 0.69 to 1.21; I2= 0%; Figure 1A) before index events did not derive benefits from DAPT. While DAPT led to significantly lower recurrent ischemic stroke (RR, 0.74; 95% CI, 0.68 to 0.81; I2= 0%; Figure 1B), it resulted in a significantly higher risk of hemorrhagic stroke, major bleeding, and intracerebral hemorrhage, compared to aspirin (Figure 1B). Moreover, the use of DAPT trended toward an increased risk of all-cause and CV mortality (Figure 1B).Conclusions:Patients with baseline statin/antiplatelts use may not derive the same benefits from DAPT for secondary prevention of non-cardioembolic ischemic stroke or TIA.

Circulation, Volume 150, Issue Suppl_1, Page A4146723-A4146723, November 12, 2024. Introduction:Atrial fibrillation (AF) is linked to an elevated risk of ischemic stroke (IS) and mortality. However, the performance of existing clinical scoring systems in assessing these outcomes is at best moderate. The blood proteome serves as a vital indicator of biological processes related to complex disorders. Consequently, there exists an opportunity to enhance the predictive accuracy of such risk scores by incorporating blood proteomic data.Purpose:In this study, we aim to evaluate the combined influence of genomics, proteomics, biomarkers, phenotypic, and social determinants of health (SDOH) on AF outcomes to better understand a precision health framework in managing AF.Methods:We analyzed patients with AF in the UK Biobank cohort who underwent proteomics measurements using the Olink Proximity Extension Assay. The primary endpoint was the incidence of IS.We assessed the intersection of multi-omics,comorbidities,SDOH and traditional CHA2DS2-VASc score to identify the most important factors associated with IS.We employed multi-step machine learning algorithms to evaluate 3,083 features, including Step1,which involved separate models for each feature type,followed by Step 2,where a combined model was used to assess the complex relationship between these features.The area under the curve (AUC) was used to compare the discriminative ability of the model with the addition of each feature group for predicting IS.Grid search and 10-fold cross-validation were performed to identify the best hyperparameters,and we calculated the mean AUC for the final models.SHAP values were reported for the top 30 features in the final XGBoost model (Figure1).Results:Among 4,842 patients with AF(mean age 67.2±9.5 years,61.8% female),5.2% experienced an IS within 9.9±7.5 years after AF diagnosis.The mean CHA2DS2-VASc score was 2.3±1.4, with 60.14% on anticoagulation therapy.The AUC for the CHA2DS2-VASc score at baseline was 0.493.Adding SDOH, polygenic scores, phenotypic data, proteomics, and biomarkers improved the model’s discriminative ability (Figure 1.A), with a combined model AUC of 0.619 (95% CI: 0.592-0.645)(Figure 1.B).The top 30 features in the final model, primarily proteins, are shown in Figure 1C.Conclusion:A small number of plasma proteins can substantially enhance risk prediction of IS in the setting of AF. Further validation could enable a single-source,personalized assessment of stroke risk in patients with AF as a gateway to personalized risk reduction therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4144471-A4144471, November 12, 2024. Introduction:The CHADS2 and CHADS2VASc scoring systems are used to determine thromboprophylaxis indication in patients with atrial fibrillation (AF). While these scoring systems include multiple independent risk factors for the development of ischemic stroke, their overall predictive performance is poor when applied to cancer populations.Research Question:To identify whether cancer serves as an independent risk factor for ischemic stroke in AF.Methods:TriNetX, a global health research database, was utilized to identify AF patients with and without malignancy from 2015 to 2022, excluding patients with prior cerebrovascular disease. Propensity score matching was conducted to control for demographic variables, heart failure, type 2 diabetes, hypertension and anticoagulation. Propensity matching yielded two cohorts consisting of 45,339 patients each. Risk and survival analyses were then run at 3 months, 6 months, 1 year, and 5 years after the index event. The primary outcome was stroke and secondary outcomes were mortality and major bleeding events.Results:At 3 months, our study showed that the incidence of stroke was higher in patients with AF and malignancy when compared to AF alone, with an odds ratio (OR) of 2.773 (p < 0.001). A Kaplan-Meier curve analysis revealed a hazard ratio (HR) of 2.683 with a confidence interval of 2.564-2.807. These results were consistent at the 6-month, 1-year and 5-year intervals, with an OR of 2.737, 2.685 and 2.167, respectively (p-value

Circulation, Volume 150, Issue Suppl_1, Page A4144621-A4144621, November 12, 2024. Background:Secondary prevention targets for embolic stroke or transient ischemic attack (TIA) are clearly described in guidelines, but many patients do not achieve consistent follow-up or adequate cardiovascular risk factor control.Aim:This study evaluated the feasibility of an intensive risk factor modification clinic model following embolic stroke compared to usual care.Methods:Eligible participants 18 to 85 years old with embolic stroke were randomly allocated to 3-monthly physician-led multi-disciplinary risk factor clinic (RFC) review or to standard follow-up for up to 3 years. Lifestyle and cardiovascular risk factors were evaluated including hypertension, hyperlipidemia, diabetes or impaired fasting glucose, physical activity, obesity, sleep apnea, alcohol and tobacco use. In the RFC group, structured advice and medication titration were provided to achieve the secondary prevention targets for each risk factor in accordance with stroke guidelines.Results:A total of 140 participants were enrolled (39% female, mean age 71±9 years), at 100±70 days post embolic stroke. Mean follow-up was 545±264 days. Risk factor clinic intervention was associated with greater likelihood of control to target for blood pressure, low density lipoprotein cholesterol (LDL-C) and achievement of target exercise volume. Average percentage weight change in participants with a body mass index (BMI) >27kg/m2was 7.5±5.4% in the treatment group compared with 1.3±4.9% in the control group (p

Circulation, Volume 150, Issue Suppl_1, Page A4146756-A4146756, November 12, 2024. Introduction:Stroke is one of the leading causes of morbidity and mortality in the United States resulting in significant health and socioeconomic burden. Accordingly, examining the temporal trends of stroke is essential for the development of effective stroke management strategies and prevention.Research Question:Is there a change in stroke mortality trends in the United States over the past 3 decades?Aim:To investigate trends in stroke mortality in the United States over the past three decades, focusing on gender and age-specific variations.Methods:We analyzed the Global Burden of Diseases 2019 database for stroke mortality trends stratified by age and gender. Trends were expressed using annual percentage change (APC) and average APC (AAPC) calculated via Joinpoint Trend Analysis Software (v5.2.0, NCI).Results:A total of 4,968,927 stroke-related mortality were reported during the time period of 1990-2019. An overall decline in the stroke-related death has been identified, with females displaying a declining mortality from 1990 to 2019 with AAPC of -0.238 (95%CI: -0.291 to -0.183; p

Circulation, Volume 150, Issue Suppl_1, Page A4139074-A4139074, November 12, 2024. Background:Early intervention with lipid lowering therapy (LLT) in patients with high cardiovascular (CV) risk before myocardial infarction or stroke may have substantial public health benefits, despite being perceived as less urgent. The effect of evolocumab in this population is being investigated in an ongoing clinical trial (NCT03872401: Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke [VESALIUS-CV]). The current ongoing observational study examines the global burden of a VESALIUS-CV-like population in the REAL-world (“VESALIUS-REAL”) in eight regions. We present data here on baseline characteristics and LLT of VESALIUS-CV like patients in the US.Methods:Using the eligibility criteria aligned with VESALIUS-CV (Figure), data were extracted from HealthVerity medical and pharmacy claims (2016-2023). A two-year observability period was required before index date; therefore, the first possible cohort entry was on January 1, 2018.Results:There were 518,852 VESALIUS-CV like patients with median age of 72 years (Q1-Q3: 64-79 years) and 56% were female (Table). Overall, 43% had coronary artery disease and 34% had high-risk diabetes mellitus (DM). Median low density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol and apolipoprotein B were 114 (Q1-Q3: 97-138) mg/dL, 141 (122-168) mg/dL and 92 (181-110) mg/dL, respectively. About 22% were on background LLT of whom 87% were on statins alone. Patients on LLT vs. no LLT were younger (median age 65 [Q1-Q3: 59-72] vs. 73 [66-80] years), had higher prevalence of tobacco users (29% vs. 17%) and high-risk DM (45% vs. 31%).Conclusions:In a large cohort of VESALIUS-CV like US patients, the majority had LDL-C sub-optimally managed with most not taking any LLT. This finding suggests an opportunity to reduce the treatment gap and improve lipid management in this population.