Stroke and other Cardiovascular disease

 

Cardiovascular disease (CVD) includes stroke, coronary artery disease, and peripheral arterial disease. All three of these disorders may result from hardening of the arteries and plaque build-up known as atherosclerosis. Cardiovascular disease risk increases due to the combination of multiple risk factors such as age, hypertension, high cholesterol, smoking, obesity, and diabetes mellitus in addition to risks from previous heart attacks, ischemic strokes, or extremities with severely narrowed blood vessels. 

 

Individuals with a cardiovascular disease are twice as likely to suffer a stroke in 10 years.[1]  Stroke risk increases if you have had a prior heart attack, heart failure, atrial fibrillation or stroke. In addition, your risk of stroke is elevated if you have subclinical cardiovascular disease as detected by non-invasive tests. Non-invasive tests include the ankle-brachial index or carotid artery ultrasound. ECG or echocardiogram abnormalities are associated with significant increased risk of incidental stroke.[2] One study of individuals over the age of 65 showed that increased left ventricular mass, left ventricular hypertrophy, and severe carotid artery narrowing were associated with two and three times higher incidences of stroke.[3]  In the study, participants with incidental strokes were more likely to have reported prior heart attacks at study entry, were more likely to have atrial fibrillation at baseline, more likely to have thickened carotid walls, and more likely to have narrowed blood vessels to the ankle as measured by the ankle-brachial index (ABI).  In addition, the potential for sudden cardiac death and unrecognized heart attack or stroke is higher in patients with diabetes.

 

Because cardiac/stroke symptoms are often masked in patients with diabetes, one way to lower stroke risk is through earlier detection of cardiovascular disease. Noninvasive tests such as MRI or CT of brain, echocardiogram/ECG, carotid artery ultrasound, coronary artery calcium, high sensitivity c-reactive protein, ankle brachial index, and exercise testing can help detect subclinical atherosclerosis. This, in turn, could result in more effective primary prevention of stroke in patients with diabetes. [4] [5]

 

[1] Smith SC Jr, Blair SN, Bonow RO, et al. AHA/ACC scientific statement:  AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update:   a statement for healthcare professionals from the American Heart Association and the American College of Cardiology.  Circulation 2001;104:1577-1579.

[2] Kuller LH et al. Diabetes Mellitus: Subclinical cardiovascular disease and risk of incident cardiovascular disease and all-cause mortality.  Atheroscler Thromb Vasc Biol. 2000;20:823-29.

[3] Manolio TA, Kronmal RA, Burke GL et al. Short-term predictors of incident stroke in older adults: The Cardiovascular Health Study.  Stroke 1996;27:1479-1486.

[4] Grundy SM, Benjamin IJ, Burke GI, et al. Diabetes and cardiovascular disease:  A statement for Healthcare Professionals from the American Heart Association, Circulation 1999;100:1134-1146.

[5] Gupta A, Giambrone AE, Gialdini G et al. Silent Brain Infarction and risk of future stroke.  A systematic Review and Meta-Analysis. Stroke 2016;47(3):719-725.

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