Biomedical subjects

Carlos S Kase

Publications and source records attributed to Carlos S Kase.

8 recordsLinked to original sources

PubMed2004

Anticardiolipin antibodies and risk of ischemic stroke and transient ischemic attack: the Framingham cohort and offspring study.

BACKGROUND AND PURPOSE: The role of anticardiolipin antibodies (aCLs) as novel risk factors for ischemic stroke and transient ischemic attacks (TIAs) has been a matter of debate. Prior cohort studies included only selected subjects, mostly men. We related serum concentrations of aCLs to incident first ischemic stroke/TIA among men and women in the Framingham Heart Study cohort and offspring. METHODS: There were a total of 2712 women (mean age, 59.3 years) and 2262 men (mean age, 58.3 years) free of stroke/TIA at the time of their baseline examinations. An enzyme immunoassay was used to measure aCLs. Optical density of the sample serum compared with the reference serum was defined as the aCL screening ratio (aCL SR). Analyses were based on sex-specific aCL SR quartiles and individual ratios. RESULTS: During the 11-year follow-up, 222 ischemic strokes/TIAs occurred. In multivariate analysis, after adjustment for age, prior cardiovascular disease, systolic blood pressure, diabetes, smoking, C-reactive protein, and total and high-density lipoprotein cholesterol levels, an aCL SR of >0.4 (78% of sample) was significantly associated with an increased risk of ischemic stroke/TIA for women (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.3 to 5.4; absolute risk, 3.2%, 95% CI, 2.2 to 4.3) but not in men (HR, 1.3; 95% CI, 0.7 to 2.4; absolute risk, 4.5%; 95% CI, 3.0 to 6.0). Similar results were obtained when the higher 3 aCL SR quartiles were compared with the lowest. CONCLUSIONS: Elevated serum concentrations of aCLs, independently of other cardiovascular risk factors, significantly predict the risk of future ischemic stroke and TIA in women but not in men.

Age Distribution↗

PubMed2003

Smoking and risk of hemorrhagic stroke in women.

BACKGROUND AND PURPOSE: Several studies established smoking as a risk factor for ischemic stroke and subarachnoid hemorrhage (SAH) in men and women. A recent study added smoking as a risk factor for intracerebral hemorrhage (ICH) in men. In contrast, the impact of smoking on ICH in women is less clear. METHODS: Prospective cohort study among 39 783 US women participating in the Women's Health Study. Smoking habits and stroke occurrence were self-reported. Stroke cases were confirmed by medical record review. We used Cox proportional hazards model to evaluate the association of smoking with risk of total hemorrhagic stroke, ICH, and SAH. We categorized smoking into never, past, and current smokers of <15 and >or=15 cigarettes per day. RESULTS: During 9 years of follow up, a total of 70 hemorrhagic strokes occurred, of which 40 were ICH and 29 were SAH. Never smokers and past smokers had equal rates of ICH and SAH. Current smokers of <15 cigarettes per day had a multivariable-adjusted relative risk (RR) of 1.93 (95% CI, 0.75 to 5.02) for total hemorrhagic stroke, 2.15 (95% CI, 0.62 to 7.43) for ICH, and 1.70 (95% CI, 0.38 to 7.60) for SAH. Women who smoked >or=15 cigarettes per day had RR of 3.29 (95% CI, 1.72 to 6.29) for total hemorrhagic stroke, 2.67 (95% CI, 1.04 to 6.90) for ICH, and 4.02 (95% CI, 1.63 to 9.89) for SAH compared with never smokers. CONCLUSIONS: This prospective study indicates an increased risk of total hemorrhagic stroke, ICH, and SAH in women who are current cigarette smokers. The risk increases with the amount of cigarettes smoked.

Cerebral Hemorrhage↗

PubMed2003

Cholesterol and the risk of ischemic stroke.

BACKGROUND AND PURPOSE: Large epidemiological studies have not established cholesterol levels as a risk factor for ischemic stroke, but recent clinical trials have demonstrated a reduction in the ischemic stroke rate for patients taking HMG-CoA reductase inhibitors ("statins"). The goal of this study was to evaluate whether total cholesterol (TC), high-density lipoprotein (HDL), triglycerides, and the TC:HDL ratio are risk factors for ischemic stroke in apparently healthy men enrolled in the Physicians' Health Study. METHODS: We used a nested case-control study design and matched 296 ischemic stroke cases with an equal number of controls on age, tobacco use, and follow-up time. At baseline, TC, HDL, and triglyceride levels were measured. We calculated odds ratios (ORs) and their 95% confidence intervals (CIs) using conditional logistic regression, adjusting for major risk factors for ischemic stroke. RESULTS: Compared with the reference lowest quartile, the highest quartile for TC had an adjusted OR of 1.56 (95% CI, 0.84 to 2.92), the highest quartile of HDL had an adjusted OR of 0.75 (95% CI, 0.43 to 1.30), and the highest quartile of triglycerides had an adjusted OR of 1.07 (95% CI, 0.63 to 1.82). Although the highest quartile of the TC:HDL ratio had an adjusted OR of 1.62 (95% CI, 0.93 to 2.82), the risk of ischemic stroke was not a linear relationship. CONCLUSIONS: After adjustment, TC, HDL, and triglycerides were not significantly associated with ischemic stroke risk, and for the TC:HDL ratio, a suggestion of increased risk of ischemic stroke was limited to those with the highest levels.

Brain Ischemia↗

PubMed2003

Smoking and the risk of hemorrhagic stroke in men.

BACKGROUND AND PURPOSE: Smoking is an established risk factor for ischemic stroke and subarachnoid hemorrhage (SAH), but the impact of smoking on intracerebral hemorrhage (ICH) is less clear. METHODS: Prospective cohort study among 22,022 US male physicians participating in the Physicians' Health Study. Incidence of stroke was measured by self-report and confirmed by medical record review. We used Cox proportional-hazards models to evaluate the association of smoking with risk of total hemorrhagic stroke, ICH, and SAH. We categorized smoking into 4 groups: never, past, or current smokers of <20 or of >or=20 cigarettes per day. RESULTS: During 17.8 years of follow-up, 108 ICHs and 31 SAHs occurred. Never smokers and past smokers had equal rates of ICH and SAH. Current smokers of <20 cigarettes per day had multivariable-adjusted relative risks of 1.65 (95% CI, 0.61 to 4.50) for total hemorrhagic stroke, 1.60 (95% CI, 0.50 to 5.07) for ICH, and 1.75 (95% CI, 0.24 to 13.09) for SAH when compared with never smokers. Current smokers of >or=20 cigarettes had relative risks of 2.36 (95% CI, 1.38 to 4.02) for total hemorrhagic stroke, 2.06 (95% CI, 1.08 to 3.96) for ICH, and 3.22 (95% CI, 1.26 to 8.18) for SAH when compared with never smokers. CONCLUSIONS: This prospective study suggests an increased risk of total hemorrhagic stroke, ICH, and SAH in current cigarette smokers with a graded increase in risk that depended on how many cigarettes were smoked. The effect of smoking on ICH is of about the same magnitude as the effect of smoking on ischemic stroke. Our results add to the multiple health benefits that can be accrued by abstaining from cigarette smoking.

Adult↗

PubMed2003

"Computed tomography-negative" intracerebral hemorrhage: case report and implications for management.

BACKGROUND: Noncontrast computed tomographic (CT) scanning of the brain is the main imaging modality recommended for the initial emergency evaluation of acute stroke. The main role of CT in this setting is to rule out intracerebral hemorrhage, especially in subjects who are potential candidates for thrombolytic therapy. OBJECTIVES AND RESULTS: We studied a patient who had symptoms suggestive of a transient ischemic attack. Although serial CT scans showed no evidence of hemorrhage, a subacute intracerebral hemorrhage was demonstrated by magnetic resonance imaging. CONCLUSIONS: This case suggests that an alternative to CT scanning should be considered in patients with acute stroke to lower the risk of an undetected intracerebral hemorrhage, especially in patients being considered for thrombolytic or anticoagulant therapy. There is evidence in the literature of other "CT-negative" cases of intracerebral hemorrhage, as well as the availability of alternative imaging techniques such as gradient echo ("susceptibility-weighted") magnetic resonance imaging sequences, which can enhance the ability of magnetic resonance imaging to detect an acute intracerebral hemorrhage.

Aged↗

PubMed2003

Interobserver agreement in the classification of stroke in the Women's Health Study.

BACKGROUND AND PURPOSE: Accurate classification of stroke events is essential in large cohort studies of risk factor assessment and in treatment trials such as the Women's Health Study (WHS). METHODS: Based on medical record review, we assessed interrater reliability in stroke classification and disability status in the WHS using the kappa statistic. RESULTS: During 7.0 years of follow-up, 271 incident strokes occurred, of which 133 were reclassified. There was excellent interrater agreement in the diagnosis of major stroke types, hemorrhagic subtypes, and degree of disability, as well as substantial agreement in the definition of the vascular territory involved. Only moderate agreement was reached in the classification of ischemic subtypes. CONCLUSIONS: Major stroke types, degree of disability, and vascular territory involved can be reliably classified on the basis of a review of medical records in the WHS, whereas classification of ischemic stroke subtypes needs further refinement of diagnostic criteria.

Cohort Studies↗

PubMed2003

Brain microembolism.

PURPOSE: To alert clinicians about the occurrence of a subtype of brain infarction, its suspected etiology, and its detection by specific neuroimaging techniques. METHODS: The article presents 5 nonconsecutive patients admitted to the stroke services of 2 tertiary care hospitals, who presented with acute or subacute symptoms suspicious, but at times atypical, of brain ischemia. FINDINGS: Each patient had evidence of 3 to > 20 small areas of recent brain infarction detected by diffusion-weighted imaging (DWI). When available, brain computerized tomography images were not helpful for the diagnosis of these recent infarcts. Most lesions were present on magnetic resonance imaging fluid-attenuated inversion recovery sequences, but the diffusion-weighted images allowed the determination of their acuity. Further evaluation revealed a potential source of embolism in each patient. Brain microembolism was suspected in all cases. CONCLUSION: Small and multiple areas of acute or subacute brain infarction occasionally present with clinical features atypical for brain embolism. They can be detected by magnetic resonance DWI studies.

Aged↗

PubMedDate not supplied

Body mass index and the risk of stroke in men.

BACKGROUND: Although obesity is an established risk factor for coronary heart disease, its role as a risk factor for stroke remains controversial. METHODS: Prospective cohort study among 21 414 US male physicians participating in the Physicians' Health Study. Incidence of total, ischemic, and hemorrhagic stroke was measured by self-report and confirmed by medical record review. We used Cox proportional hazards models to evaluate the association of body mass index (BMI), calculated as self-reported weight in kilograms divided by the square of the height in meters, with risk of total, ischemic, and hemorrhagic stroke. RESULTS: During 12.5 years of follow-up, 747 strokes (631 ischemic, 104 hemorrhagic, and 12 undefined) occurred. Compared with participants with BMIs less than 23, those with BMIs of 30 or greater had an adjusted relative risk of 2.00 (95% confidence interval [CI], 1.48-2.71) for total stroke, 1.95 (95% CI, 1.39-2.72) for ischemic stroke, and 2.25 (95% CI, 1.01-5.01) for hemorrhagic stroke. When BMI was evaluated as a continuous variable, each unit increase of BMI was associated with a significant 6% increase in the adjusted relative risks of total (95% CI, 4%-8%), ischemic (95% CI, 3%-8%), and hemorrhagic stroke (95% CI, 1%-12%). Additional adjustment for hypertension, diabetes mellitus, and hypercholesterolemia slightly attenuated the risks for total and ischemic (relative risk, 4%; 95% CI, 2%-7%), but not hemorrhagic, stroke. CONCLUSIONS: These prospective data indicate a significant increase in the relative risk of total stroke and its 2 major subtypes with each unit increase of BMI that is independent of the effects of hypertension, diabetes, and cholesterol. Because BMI is a modifiable risk factor, the prevention of stroke may be another benefit associated with preventing obesity in adults.

Age Factors↗