Browsing by Author "Rothwell, P."

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    Comparison of Risk Factors for Stroke Subtypes versus Acute Coronary Syndrome: A Population-Based Study
    (Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mettananda, C.; Rothwell, P.; Li, L.; Mehta, Z.; Gutnikov, S.
    Stroke and acute coronary syndromes (ACS) share risk factors, but population-based data on differential associations with stroke subtype and ACS are limited. We studied pre-morbid risk factors in stroke subtypes and acute coronary syndrome. We studied all first-ever TIA/strokes and ACS from 2002-2012 in a population-based cohort (Oxford Vascular Study). Risk associations were compared by logistic regression, adjusted for age and sex, for hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, current smoking and over-weight (BMI > 25). 1913 TIA/ischaemic strokes (mean age 71.6 years, women 53.9%), 112 intracerebral haemorrhages (ICH) (mean age 71.0 years, 51.8% women) and 1191 ACS (mean age 71.35 years, 35.4% women) were studied. Compared to ACS, hypertension (adjusted OR=1.34, 95%CI=1.15-1.56, p < 0.001), hyperlipidaemia (1.27, 1.07-1.50, p=0.006) and atrial fibrillation (1.40, 1.12-1.76, p=0.004) were more strongly associated with TIA/ischemic stroke than with ACS. However, diabetes mellitus (0.71, 0.57-0.88, p=0.002), current smoking (0.62, 0.51-0.75, p= < 0.001) and over-weight (0.78, 0.65-0.93, p=0.007) were negatively associated with TIA/ischemic stroke compared with ACS. For ICH, hypertension (1.85, 1.22-2.81, p=0.004) was more strongly associated than with ACS, whereas hyperlipidaemia (0.56, 0.32-0.97, p=0.039), current smoking (0.40, 0.21-0.74, p=0.004) and over-weight (0.64, 0.42-0.99, p=0.045) were negatively associated. When ICH was compared with TIA/ischemic stroke, the negative associations with hyperlipidaemia (0.43, 0.25-0.74, p=0.002) remained. Results were unchanged after exclusion of TIA. Diabetes mellitus, current smoking and obesity are more strongly associated with ACS than with stroke, whereas hypertension is a stronger risk factor for ischaemic and haemorrhagic stroke. Hyperlipidaemia is negatively associated with ICH.
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    Premorbid blood pressure control of incident transient ischaemic attacks and strokes; prevalence and determinants; Analysis of individual patient data over 10 Years
    (Lippincott Williams & Wilkins, 2017) Mettananda, C.; Li, L.; Lau, G.; Wharton, R.; Bull, L.; McCulloch, E.; Welch, S.; Mehta, Z.; Silver, L.; Rothwell, P.; Oxford Vascular Study
    BACKGROUND: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. AIMS AND METHODS: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. RESULTS: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP. CONCLUSIONS: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.