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Biomedical subjects

Philip B Gorelick

Publications and source records attributed to Philip B Gorelick.

At least 19 recordsLinked to original sources
PubMed2007

Reduction of stroke risk factors.

In October 2006, a panel of experts participated in a teleconference to discuss the reduction of stroke risk factors in patients at risk for stroke. The panel was chaired by John B. Kostis, MD, Professor and Chairman, Department of Medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ. Also participating were Philip B. Gorelick, MD, MPH, Director, Center for Stroke Research, University of Illinois College of Medicine, Chicago, IL, and Franz H. Messerli, MD, St Luke's-Roosevelt Hospital Center, New York, NY.

Antihypertensive Agents↗
PubMed2006

Risk of cardiovascular events in patients receiving celecoxib: a meta-analysis of randomized clinical trials.

Some nonsteroidal anti-inflammatory drugs (NSAIDs), including cyclooxygenase-2 selective inhibitors, have been associated with increased cardiovascular (CV) events in recent clinical trials or observational studies. To determine whether the cyclooxygenase-2 selective inhibitor celecoxib affects CV risk, the incidence of CV events was analyzed in patients treated with celecoxib, placebo, or nonselective NSAIDs in the clinical trial database for celecoxib using defined Antiplatelet Trialists' Collaboration end points of nonfatal myocardial infarction, nonfatal stroke, and CV death. Patient data were derived from studies in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, low back pain, and Alzheimer's disease. This meta-analysis included (1) 7,462 patients exposed to celecoxib 200 to 800 mg/day for 1,268 patient-years compared with 4,057 patients treated with placebo for 585 patient-years, and (2) 19,773 patients treated with celecoxib 200 to 800 mg/day for 5,651 patient-years compared with 13,990 patients treated with nonselective NSAIDs (diclofenac, ibuprofen, naproxen, ketoprofen, and loxoprofen) for 4,386 patient-years. CV events were adjudicated by a 3-member expert end point committee (WBW, JSB, PBG) blinded to treatment group and study. The incidence rates of the combined CV events were not significantly different between patients treated with celecoxib and placebo or between those treated with celecoxib and nonselective NSAIDs. Event rates were similar for adjudicated and nonadjudicated data. Dose of celecoxib, the use of aspirin, or the presence of CV risk factors did not alter these results. In conclusion, these analyses failed to demonstrate an increased CV risk with celecoxib relative to placebo and demonstrated a comparable rate of CV events with celecoxib treatment compared with nonselective NSAIDs.

Administration, Oral↗
PubMed2006

Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline.

BACKGROUND AND PURPOSE: This guideline provides an overview of the evidence on various established and potential stroke risk factors and provides recommendations for the reduction of stroke risk. METHODS: Writing group members were nominated by the committee chair on the basis of each writer's previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee. The writers used systematic literature reviews (covering the time period since the last review published in 2001 up to January 2005), reference to previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate recommendations based on standard American Heart Association criteria. All members of the writing group had numerous opportunities to comment in writing on the recommendations and approved the final version of this document. The guideline underwent extensive peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS: Schemes for assessing a person's risk of a first stroke were evaluated. Risk factors or risk markers for a first stroke were classified according to their potential for modification (nonmodifiable, modifiable, or potentially modifiable) and strength of evidence (well documented or less well documented). Nonmodifiable risk factors include age, sex, low birth weight, race/ethnicity, and genetic factors. Well-documented and modifiable risk factors include hypertension, exposure to cigarette smoke, diabetes, atrial fibrillation and certain other cardiac conditions, dyslipidemia, carotid artery stenosis, sickle cell disease, postmenopausal hormone therapy, poor diet, physical inactivity, and obesity and body fat distribution. Less well-documented or potentially modifiable risk factors include the metabolic syndrome, alcohol abuse, drug abuse, oral contraceptive use, sleep-disordered breathing, migraine headache, hyperhomocysteinemia, elevated lipoprotein(a), elevated lipoprotein-associated phospholipase, hypercoagulability, inflammation, and infection. Data on the use of aspirin for primary stroke prevention are reviewed. CONCLUSIONS: Extensive evidence is available identifying a variety of specific factors that increase the risk of a first stroke and providing strategies for reducing that risk.

Brain Ischemia↗
PubMed2006

Update on the management of hypertension to prevent stroke.

Hypertension is the leading modifiable risk factor for stroke, including first-ever and recurrent stroke. The association between blood pressure (BP) and stroke risk is continuous and may be documented as low as 115/75 mm Hg. Because of this continuum of risk, and because most strokes occur in individuals with mild hypertension or even normal BP values, we are now beginning to recognize "prehypertension" as a stage in which early recognition and intervention may confer benefit. In addition to increased risk for ischemic and hemorrhagic stroke, hypertension may be associated with increased risk of cognitive impairment. Reductions in BP are reliably associated with reduced stroke risk. Some evidence suggests that certain agents, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, may have protective effects beyond BP lowering. Overall, the degree of BP lowering is key, and therefore most classes of BP-lowering agents may be recommended at this point. Many patients with hypertension will require more than one BP-lowering agent to control BP. Lifestyle modification is appropriate at all levels of intervention. Further studies are needed to ascertain the mechanisms of benefit of different classes of antihypertensive agents in the reduction of stroke and cardiovascular disease risk.

Journal Article↗
PubMed2005

Longitudinal changes in white matter following ischemic stroke: a three-year follow-up study.

Information on longitudinal changes in white matter after stroke is limited. The aim of the present study was to quantitatively investigate longitudinal changes in the microstructural integrity of non-lesioned white matter at 1-3 years following ischemic stroke. In a sample of 80 ischemic stroke patients, we obtained diffusion tensor imaging (DTI) measures of fractional anisotropy (FA), an apparent measure of white matter integrity, in radiologically normal-appearing white matter at baseline and 3 years of follow-up. Mixed model regression analysis results showed a significant improvement in FA from baseline during the first 2 years of follow-up that stabilized by the third year of follow-up. These results demonstrate a long-term improvement in apparent white matter integrity following ischemic stroke that continues, at least, into the second year following the insult.

Aged↗
PubMed2005

Risk of hemorrhagic stroke with aspirin use: an update.

BACKGROUND: Low-dose aspirin is an important therapeutic option in the secondary prevention of myocardial infarction (MI) and ischemic stroke, especially in light of its unique cost-effectiveness and widespread availability. In addition, based on the results of a number of large studies, aspirin is also widely used in the primary prevention of MI. This review provides an update of the available data to offer greater clarity regarding the risks of aspirin with respect to hemorrhagic stroke, as well as insights regarding patient selection to minimize the risk of this complication. SUMMARY OF REVIEW: In the secondary prevention of cardiovascular, cerebrovascular, and ischemic events, the evidence supports that the benefits of aspirin treatment significantly outweigh the risk of a major hemorrhage. The evidence from primary prevention of MI studies, including that from the recent Women's Health Study evaluation of aspirin use in healthy women, demonstrate that the increased risk for hemorrhagic stroke is small, is comparable to the secondary prevention studies, and fails to achieve statistical significance. A reasonable estimate of the risk of hemorrhagic stroke associated with the use of aspirin in primary prevention patients is 0.2 events per 1000 patient-years, which is comparable to estimates of the risk associated with the use of aspirin in secondary prevention patients. CONCLUSIONS: When considering whether aspirin is appropriate, the absolute therapeutic cardiovascular benefits of aspirin must be balanced with the possible risks associated with its use, with the most serious being hemorrhagic stroke.

Adult↗
PubMed2005

William M. Feinberg Lecture: Cognitive vitality and the role of stroke and cardiovascular disease risk factors.

BACKGROUND AND PURPOSE: Vascular risk factors are common in the elderly, and some such as hypertension may be important predictors of cognitive impairment. SUMMARY OF REVIEW: In this article, the role that vascular risk factors may play in the prevention of vascular and nonvascular forms of cognitive impairment is reviewed. CONCLUSIONS: Because vascular risk factors may have negative effects on brain structure and cognitive function, and because vascular risk factors may be present in midlife or possibly earlier, we may need to develop long-term intervention strategies to control or prevent vascular risk factors in an effort to preserve cognitive vitality as we age.

Aged↗
PubMed2005

Impact of obesity and the metabolic syndrome on risk factors in African American stroke survivors: a report from the AAASPS.

BACKGROUND: The rates of obesity and the metabolic syndrome and the impact on traditional vascular risk factors in African American stroke survivors are unknown. OBJECTIVE: To describe the relationships between body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and hypertension, dyslipidemia, and diabetes mellitus. DESIGN: We classified 1711 subjects as underweight (BMI, <18.5), normal (BMI, 18.5-24.9), overweight (BMI, 25.0-29.9), or obesity class 1 (BMI, 30.0-34.9), 2 (BMI, 35.0-39.9), or 3 (BMI, >40.0). We compared the proportions with hypertension, dyslipidemia, and diabetes mellitus and control of these factors by clinical history and results of physical examination and laboratory analysis across BMI groups. SETTING: Multicentered clinical trial. PATIENTS: African American subjects with previous ischemic stroke. MAIN OUTCOME MEASURES: Rates of obesity and the metabolic syndrome, odds ratios (ORs) of associated vascular risk factors at baseline, and relationship to longitudinal risk factor control. RESULTS: Overall, 76% were overweight or obese (70% of men and 81% of women). Hypertension, dyslipidemia, and diabetes mellitus were all present in 43.3% of men and 29.1% of women with obesity class 3. The ORs for having the metabolic syndrome were 2.14 (95% confidence interval [CI], 1.52-3.01) for class 1, 1.92 (95% CI, 1.26-2.91) for class 2, and 1.98 (95% CI, 1.27-3.09) for class 3 obesity. In addition, increasing BMI was negatively associated with systolic (P<.001) and diastolic (P<.001) blood pressure and glycemic control (P<.001). CONCLUSION: Our analysis of the data from the African American Antiplatelet Stroke Prevention Study supports the association of increasing risk factor profiles with increasing weight in African American stroke survivors.

Adult↗
PubMed2005

Stroke in Black Americans.

Black Americans bear a disproportionate stroke burden in the United States compared with other racial and ethnic groups. Poor stroke awareness, higher vascular risk factor burden, limited access to care, mistrust of the medical system, and inequities in diagnostic testing and treatment usage may account for some of the disparity. In addition, blacks have historically been under-represented in observational studies and clinical trials of stroke prevention and treatment. Therefore, our knowledge regarding stroke in black Americans is somewhat limited. This article provides an update on developments in our understanding regarding stroke in this at-risk population.

Black or African American↗
PubMed2005

Epidemiology of stroke in African Americans and Hispanic Americans.

Many minorities continue to experience disparities in the level of their personal health and overall health care in the United States. This article explores disparities in stroke as they relate to two minority populations: African Americans and Hispanic Americans. These two groups have been chosen for review and discussion because the available epidemiologic databases are relatively broad, and the authors have personal experience in the conduct of research studies in these populations.

Black or African American↗
PubMed2004

Risk factors for vascular dementia and Alzheimer disease.

Alzheimer disease and vascular cognitive impairment are important causes of cognitive decline in the elderly. It has now been shown that vascular risk factors have measurable negative effects on the brain and are associated with cognitive impairment. We review vascular factors that might be responsible to cognitive decline in Alzheimer disease and vascular cognitive impairment and the corresponding interventions that might prevent cognitive impairment as we age.

Alzheimer Disease↗
PubMed2004

Direct medical costs attributable to acute myocardial infarction and ischemic stroke in cohorts with atherosclerotic conditions.

BACKGROUND: The cost of acute ischemic events in persons with established atherosclerotic conditions is unknown. METHODS: The direct medical costs attributable to secondary acute myocardial infarction (AMI) or ischemic stroke among persons with established atherosclerotic conditions were estimated from 1995-1998 data on 1,143 patients enrolled in US managed care plans. RESULTS: The average 180-day costs attributable to secondary AMI or stroke were estimated as USD 19,056 in the AMI cohort having a private insurance (commercial; n = 344), USD 16,845 in the AMI cohort having government insurance (Medicare, age >/=65 years; n = 200), USD 10,267 for stroke commercial (n = 108), USD 16,280 for stroke Medicare (n = 113), USD 15,224 for peripheral arterial disease commercial (n = 170), and USD 15,182 for peripheral arterial disease Medicare (n = 208). CONCLUSION: These estimates can be used to study the cost-effectiveness of interventions proven to reduce these secondary events.

Aged↗