Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 34,264 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label sickle cell disease. Show all posts
Showing posts with label sickle cell disease. Show all posts
Black adults with sickle cell trait did not have an increased risk for ischemic stroke, according to a meta-analysis published in JAMA Neurology.
Hyacinth I. Hyacinth, MD, PhD, MPH, associate professor in the department of pediatrics at Emory University School of Medicine, and colleagues analyzed data from 19,464 black adults (mean age, 60 years; 27% men) from four studies: Jackson Heart Study, REGARDS, MESA and Women’s Health Initiative. Of these participants, 1,520 had sickle cell trait and 620 had incident ischemic stroke.
Baseline information was collected by self-report and in-person examination, and patients were followed up annually or semiannually for the occurrence of CV events, including stroke. Exclusion criteria for this meta-analysis included those with a history of stroke at baseline and incident hemorrhagic stroke.
Risk factors, age at ischemic stroke event and the number of strokes did not differ in patients with and without sickle cell trait.
The crude incidence of ischemic stroke was similar in people with sickle cell trait (2.9 per 1,000 person-years; 95% CI, 2.2-4) and without it (3.2 per 1,000 person-years; 95% CI, 2.7-3.8). After adjusting for stroke risk factors, HRs did not significantly differ between both groups (HR = 0.8; 95% CI, 0.47-1.35).
Results were similar in both the individual cohorts and the meta-analysis.
“Future studies with large numbers of African-Americans, longer follow-up and carefully subtyped ischemic stroke events are needed to further elucidate the possible association of [sickle cell trait] with incident ischemic stroke overall and by specific ischemic stroke subtypes,” Hyacinth and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
by Judy George, Contributing Writer, MedPage Today
This article is a collaboration between MedPage Today® and:
Action Points
No association was found between sickle cell trait and the incidence of ischemic stroke among African Americans, in a meta-analysis of four studies with 19,464 African-American participants.
Note that these data suggest that when a patient with sickle cell trait presents with stroke and no apparent traditional risk factors, a more thorough work-up should be done instead of assuming that the stroke is due to sickle cell trait.
Sickle cell trait may not be an independent genetic risk factor for ischemic stroke among African Americans, a new meta-analysis suggests.
In a review of four studies with more than 19,000 African-American participants, Hyacinth I. Hyacinth, MD, PhD, MPH, of Emory University School of Medicine in Atlanta, and colleagues reported no association between heterozygosity for the sickle cell mutation or sickle cell trait and incidence of ischemic stroke in JAMA Neurology.
"Sickle cell trait was not associated with a higher risk of ischemic stroke among African Americans," Hyacinth told MedPage Today. "This negative study and its findings are important as we attempt to develop more targeted approaches for stroke prevention."
"Significant stroke disparity exists between African Americans and non-Hispanic whites," he said. "Because this disparity is not explained by traditional risk factors such as access to healthcare, identifying biological factors that account for the differences is an important strategy for stroke prevention."
This negative result tells neurologists to dig deeper, Hyacinth added: "When a patient with sickle cell trait presents with stroke and no apparent traditional risk factors, a more thorough work-up should be done, instead of just pinning the stroke on the fact that the patient has sickle cell trait."
Case reports have suggested that sickle cell trait, a genetic variant that is present almost exclusively in African Americans, and ischemic stroke are linked. A prospective, population-based study also reported an association between sickle cell trait and incident stroke in African Americans.
The meta-analysis included four prospective studies that evaluated cardiovascular disease risk factors in U.S. populations: the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis (MESA), Reasons for Geographic and Racial Differences in Stroke (REGARDS), and Women's Health Initiative.
The four studies examined 19,464 African Americans with an average age of 60; 27% were men and 73% women. In total, 1,520 people had sickle cell trait and 620 people had incident ischemic stroke. Sickle cell trait prevalence ranged from 7.7% to 9% and averaged 7.8%, consistent with estimates in the African American population.
In each cohort, the distribution of risk factors, number of strokes, and age at ischemic stroke event was similar between patients with and without sickle cell trait.
In the meta-analysis, the crude incident rate for ischemic stroke did not vary between individuals who had sickle cell trait (2.9 per 1,000 person years) and those who did not (3.2 per 1,000 person-years). After adjusting for stroke risk factors, the hazard ratio of incident ischemic stroke independently associated with sickle cell trait was 0.80 (95% CI 0.47-1.35, P=0.82). Meta-analysis results were similar to those of individual cohorts.
"We know ischemic stroke is increased in individuals with sickle cell disease, but prior studies looking for an association with sickle cell trait have been mixed," observed Sarah Lee, MD, of the Stanford University School of Medicine, who was not involved in the study.
"This large meta-analysis confirms our suspicion that sickle cell trait does not seem to confer an increased risk of stroke, and will be helpful when counseling patients and considering stroke prevention in this population," Lee told MedPageToday.
Hyacinth and co-authors noted that previous evidence of an association between sickle cell trait and ischemic stroke included the longitudinal Atherosclerosis Risk in Communities (ARIC) study of 3,497 African Americans that reported a 1.4-fold increased risk of ischemic stroke in sickle cell trait carriers.
Several factors could explain why those results vary from this meta-analysis. In the meta-analysis, the number of people with sickle cell trait in age groups with greater risk of stroke in each cohort was relatively small, so differences may have been caused by chance. It's also possible different covariates were used.
In the meta-analysis, researchers adjusted for left ventricular hypertrophy; the ARIC study did not make that adjustment. But adjusting for left ventricular hypertrophy did not change the direction of estimate effects, the authors noted.
One limitation of the meta-analysis was possible misclassification, as about 48% of the sample were not genotyped directly. However, effect estimates and lack of association were similar in studies with and without direct genotyping. The researchers also could not test the association of sickle cell trait with ischemic stroke subtypes, so it remains possible that a link exists between sickle cell trait and one or more stroke subtype.
This work was supported in part by the National Cancer Institute and the Intramural Research Program of the NIH.
The researchers reported no conflicts of interest.
Reviewed by
Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Only 2 paragraphs here, rest at link.
Publication of the STOP trial, in which long-term blood transfusions
were effective for preventing stroke in children with sickle cell
anemia, was associated with a reduction in the racial disparity in
stroke mortality, researchers found.
Compared with white children, black children had a greater risk of
dying from ischemic stroke both before and after the trial results were
announced, but the relative risk declined from 1.74 (95% CI 1.42-2.13)
to 1.27 (95% CI 0.99-1.64), according to Laura Lehman, MD, of Boston
Children's Hospital, and Heather Fullerton, MD, of the University of
California San Francisco.
