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Biomedical subjects

Valery Feigin

Publications and source records attributed to Valery Feigin.

16 recordsLinked to original sources
PubMed2007

Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region.

OBJECTIVE: About half of the world's burden of cardiovascular disease is carried by countries in the Asia-Pacific region. This study aimed to quantify the contribution of hypertension to cardiovascular diseases (CVD) at the country level, by calculating the sex-specific, population-attributable fractions (PAFs) for fatal ischaemic heart disease (IHD) and stroke (haemorrhagic and ischaemic) for the World Health Organization Western Pacific and South-east Asian regions. METHODS: The most recent sex-specific prevalence data on hypertension were sought. Age-adjusted hazard ratio (HR) estimates for fatal IHD and stroke associated with hypertension were obtained using Cox analyses of individual participant cohort data from 600,000 adult participants in the Asia-Pacific Cohort Studies Collaboration. HR estimates and prevalence were then used to calculate sex-specific PAFs for fatal IHD and stroke, by country. RESULTS: In 15 countries with available data, the prevalence of hypertension ranged from 5-47% in men and from 7-38% in women. Overall, the fraction of IHD attributable to hypertension ranged from 4-28% in men and from 8-39% in women. Corresponding ranges for haemorrhagic stroke were 18-66% and 15-49%, and for ischaemic stroke were 8-44% and 12-45%. CONCLUSIONS: In the Asia-Pacific region, up to 66% of some subtypes of CVD can be attributed to hypertension, underscoring the immense impact that blood pressure- lowering strategies could have in this populous region.

Adult↗
PubMed2006

Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003.

BACKGROUND AND PURPOSE: Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke in New Zealand. This paper reports on the burden of stroke in women across different ethnic groups over the study period from 1981 to 2003. METHODS: Three studies using similar methodology and overlapping case finding methods have been conducted in New Zealand to estimate trends in the incidence and outcome of stroke. The studies are recognised as meeting the 'ideal' criteria for stroke incidence and identify all first-ever and recurrent strokes in residents (aged greater than and equal to 15 years) the population of Auckland, New Zealand in the 12-month periods from 1981-1982, 1991-1992, and 2002-2003. There were totals of 307,578 strokes among women in 1981, 372,642 in 1991, and 470,727 in 2001, according to each Census representing over 50% of the population at each period (51%-54%). The WHO standard world population was used for direct age standardisation of annual rates (per 100,000 population), reported with 95% confidence intervals (CI). RESULTS: The proportion of women who have experienced a stroke did not change markedly over the study period but there were ethnic differences emerging which were related to population changes within the New Zealand population. Standardised stroke incidence in women was relatively stable across the three study periods (1981-1982), 133 [95% CI 118-151]; (1991-1992), 143 [95% CI 116-241]; and (2002-2003), 124 [95% CI 115-134]). However, a significant decline of 14% (95% CI 2%-29%) in rates of first-ever stroke was found between 1991-1992 and 2002-2003 in women. In contrast to the significant declines in event rates in European women over two decades (Rate ratio 0.84, 95% CI 0.73-0.96), increasing trends in event rates in Pacific women were observed (2.71 95% CI 1.00-7.29). The rate of stroke for Maori women did not change significantly over time. Over half of the women who had a stroke event reported that they had high blood pressure; one in four reported that they had diabetes. The proportion of women who smoked declined over time but increases in body mass index (BMI) indicated weight gains in women over time. These trends were consistent across ethnic groups. Women's survival after 1 month following their stroke has improved by 39% (p<0.0001) over the 20-year period. Favourable changes in early survival were most pronounced in European women. CONCLUSIONS: There was a modest decline in stroke incidence in women (overall and for New Zealand European women in particular) in Auckland over the past 20 years but there also was a trend towards increasing stroke incidence in Maori, Pacific, and Asian women. These divergent trends are likely to be associated with different trends in the prevalence of risk factors in these ethnic populations. Targeted stroke prevention programmes are needed in New Zealand to meet the needs of specific ethnic groups as well as the needs of providing ongoing care and support to women following their stroke.

Adolescent↗
PubMed2006

The impact of neuropsychological deficits on functional stroke outcomes.

This review examines the available literature on neuropsychological outcomes of stroke and the literature on the ability of specific areas of neuropsychological deficit to predict functional stroke outcome. The literature reviewed indicates that post-stroke deficits in executive function, memory, language, and speed of processing are common, with those identified as having progressive 'post-stroke dementia' presenting with a similar, though more impaired profile, with increased impairments particularly noted in the area of memory. It is clear that some aspects of neuropsychological functioning (e.g., presence of neglect, aphasia, anosognosia; and verbal memory and attention deficits) show promise as a means of predicting post-stroke functional outcomes. Examining the available literature, it becomes evident that there is a need for long-term, large scale (i.e., population based) follow-up studies, evaluating likely long-term neuropsychological outcomes of stroke and their prognostic utility.

Brain Damage, Chronic↗
PubMed2006

Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002-2003.

BACKGROUND: Limited population-based data exist on differences in the incidence of major pathological stroke types and ischaemic stroke subtypes across ethnic groups. We aimed to provide such data within the large multi-ethnic population of Auckland, New Zealand. METHODS: All first-ever cases of stroke (n=1423) in a population-based register in 940 000 residents (aged 15 years) in Auckland, New Zealand, for a 12-month period in 2002-2003, were classified into ischaemic stroke, primary intracerebral haemorrhage (PICH), subarachnoid haemorrhage, and undetermined stroke, according to standard definitions and results of neuroimaging/necropsy (in over 90% of cases). Ischaemic stroke was further classified into five subtypes. Ethnicity was self-identified and grouped as New Zealand (NZ)/European, Maori/Pacific, and Asian/other. Incidence rates were standardised to the WHO world population by the direct method, and differences in rates between ethnic groups expressed as rate ratios (RRs), with NZ/European as the reference group. FINDINGS: In NZ/European people, ischaemic stroke comprised 73%, PICH 11%, and subarachnoid haemorrhage 6%, but PICH was higher in Maori/Pacific people (17%) and in Asian/other people (22%). Compared with NZ/European people, age-adjusted RRs for PICH were 2.7 (95% CI 1.8-4.0) and 2.3 (95% CI 1.4-3.7) among Maori/Pacific and Asian/other people, respectively. The corresponding RR for ischaemic stroke was greater for Maori/Pacific people (1.7 [95% CI 1.4-2.0]), particularly embolic stroke, and for Asian/other people (1.3 [95% CI 1.0-1.7]). The onset of stroke in Maori/Pacific and Asian/other people began at significantly younger ages (62 years and 64 years, respectively) than in NZ/Europeans (75 years; p<0.0001). There were ethnic differences in the risk factor profiles (such as age, sex, hypertension, cardiac disease, diabetes, hypercholesterolaemia, smoking status, overweight) for the stroke types and subtypes. INTERPRETATION: Compared to NZ/Europeans, Maori/Pacific and Asian/other people are at higher risk of ischaemic stroke and PICH, whereas similar rates of subarachnoid haemorrhage were evident across ethnic groups. The ethnic disparities in the rates of stroke types could be due to substantial differences found in risk factor profiles between ethnic groups. This information should be considered when planning prevention and stroke-care services in multi-ethnic communities.

Adolescent↗
PubMed2005

Trends in ethnic disparities in stroke incidence in Auckland, New Zealand, during 1981 to 2003.

BACKGROUND AND PURPOSE: Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence. METHODS: We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981 to 1982, 1991 to 1992, and 2002 to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as "NZ/European," "Maori," "Pacific peoples," and "Asian and other." RESULTS: Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups. CONCLUSIONS: Divergent trends in ethnic-specific stroke incidence and attack rates, and of associated risk factors, have occurred in Auckland over recent decades. The findings provide mixed views as to the future burden of stroke in populations undergoing similar lifestyle and structural changes.

Adolescent↗
PubMed2005

Trends in stroke incidence in Auckland, New Zealand, during 1981 to 2003.

BACKGROUND AND PURPOSE: Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance. METHODS: We assessed temporal trends in stroke incidence using standard diagnostic criteria and community-wide surveillance procedures in the population (approximately 1 million) of Auckland, New Zealand, over 12-month calendar periods in 1981-1982, 1991-1992, and 2002-2003. Age-adjusted first-ever (incident) and total (attack) rates, and temporal trends, were reported with 95% confidence intervals (CIs). Rates were analyzed by sex and major age groups. RESULTS: From 1981 to 1982, stroke rates were stable in 1991-1992 and then declined in 2002-2003, to produce overall modest declines in standardized incidence (11%; 95% CI, 1 to 19%) and attack rates (9%; 95% CI, 0 to 16%) between the first and last study periods. Some favorable downward trends in vascular risk factors such as cigarette smoking were counterbalanced by increasing age and body mass index, and frequency of diabetes, in patients with stroke. CONCLUSIONS: There has been a modest decline in stroke incidence in Auckland over the last 2 decades, mainly during 1991 to 2003, in association with divergent trends in major risk factors.

Age Factors↗
PubMed2005

Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants.

BACKGROUND AND PURPOSE: The cause of subarachnoid hemorrhage (SAH) is poorly understood and there are few large cohort studies of risk factors for SAH. We investigated the risk of SAH mortality and morbidity associated with common cardiovascular risk factors in the Asia-Pacific region and examined whether the strengths of these associations were different in Asian and Australasian (predominantly white) populations. METHODS: Cohort studies were identified from Internet electronic databases, searches of proceedings of meetings, and personal communication. Hazard ratios (HRs) for systolic blood pressure (SBP), current smoking, total serum cholesterol, body mass index (BMI), and alcohol drinking were calculated from Cox models that were stratified by sex and cohort and adjusted for age at risk. RESULTS: Individual participant data from 26 prospective cohort studies (total number of participants 306,620) that reported incident cases of SAH (fatal and/or nonfatal) were available for analysis. During the median follow-up period of 8.2 years, a total of 236 incident cases of SAH were observed. Current smoking (HR, 2.4; 95% CI, 1.8 to 3.4) and SBP >140 mm Hg (HR, 2.0; 95% CI, 1.5 to 2.7) were significant and independent risk factors for SAH. Attributable risks of SAH associated with current smoking and elevated SBP (> or =140 mm Hg) were 29% and 19%, respectively. There were no significant associations between the risk of SAH and cholesterol, BMI, or drinking alcohol. The strength of the associations of the common cardiovascular risk factors with the risk of SAH did not differ much between Asian and Australasian regions. CONCLUSIONS: Cigarette smoking and SBP are the most important risk factors for SAH in the Asia-Pacific region.

Adult↗
PubMed2005

Does blood pressure lowering treatment prevents dementia or cognitive decline in patients with cardiovascular and cerebrovascular disease?

There is increasing evidence that both hypertension and stroke play important roles in the development of cognitive decline and dementia. Despite five high-quality randomised controlled trials (RCTs) in this area to date, there remains uncertainty about the role of blood pressure lowering therapy in the prevention of cognitive decline and dementia. It appears that lack of definitive results from these trials can be explained on the basis of (a) insufficient power to detect modest treatment effects; (b) measurement error in the diagnosis of dementia; (c) variations in the treatment effects between different types of antihypertensive agents; and (d) bias due to missing data, variation in baseline factors such as levels of blood pressure, and the inclusion of patients with cognitive impairment at entry. Preliminary meta-analysis of RCTs supports the hypothesis that blood pressure lowering may prevent dementia in high-risk patients, that is those with vascular disease. However, a meta-analysis of individual patient data (IPD) from these, and other relevant trials in patients with vascular disease, would provide much more reliable data. If the hypothesis were confirmed, it would certainly be of considerable importance not only in terms of our understanding of the aetiology of dementia, but also in promoting blood pressure lowering strategies for broader public health good.

Aged↗
PubMed2004

Diurnal, weekly, and seasonal variations in stroke occurrence in a population-based study in Auckland, New Zealand.

AIMS: To determine (via a population-based study in Auckland, New Zealand) if there are diurnal, weekly, or seasonal variations in the occurrence of stroke. METHODS: All new stroke events in Auckland residents were traced. Time of onset of the stroke was defined as the time when neurological symptoms were first noticed. The day of the week and month of onset were analysed for all strokes. RESULTS: 1711 patients were registered over 1 year. The rate ratios for the onset of stroke in each 6-hourly interval compared with reference interval (1800-2359 hours) were 0.74 (95% CI: 0.61-1.10) for 0000-0559 hours, 2.88 (95% CI: 2.48-3.34) for 0600-1159 hours and 1.74 (95% CI: 1.49-2.05) for 1200-1759 hours. Rate ratios of the seasonal occurrence of stroke compared with spring were 0.75 (95% CI: 0.65-0.86) for summer, 0.83 (95% CI: 0.73-0.95) for autumn and 1.08 (95% CI: 0.96-1.23) for winter. No weekly pattern of stroke occurrence was observed. CONCLUSIONS: Strokes were less likely to occur during the summer and autumn than in the winter or spring. There was an increase in the occurrence of stroke in the late morning. The results have implications for the provision of acute stroke services in the community and in hospital.

Humans↗
PubMed2004

Active and passive smoking and the risk of subarachnoid hemorrhage: an international population-based case-control study.

BACKGROUND AND PURPOSE: This study was undertaken to better clarify the risks associated with cigarette smoking and subarachnoid hemorrhage (SAH). METHODS: The study included 432 incident cases of SAH frequency matched to 473 community SAH-free controls to determine dose-dependent associations of active and passive smoking (at home) and smoking cessation with SAH. RESULTS: Compared with never smokers not exposed to passive smoking, the adjusted odds ratio for SAH among current smokers was 5.0 (95% confidence interval [CI], 3.1 to 8.1); for past smokers, 1.2 (95% CI, 0.8 to 2.0); and for passive smokers, 0.9 (95% CI, 0.6 to 1.5). Current and lifetime exposures showed a clear dose-dependent effect, and risks appeared more prominent in women and for aneurysmal SAH. Approximately 1 in 3 cases of SAH could be attributed to current smoking, but risks decline quickly after smoking cessation, even among heavy smokers. CONCLUSIONS: A strong positive association was found between cigarette smoking and SAH, especially for aneurysmal SAH and women, which is virtually eliminated within a few years of smoking cessation. Large opportunities exist for preventing SAH through smoking avoidance and cessation programs.

Australia↗
PubMed2002

Determinants of major non-communicable diseases in the elderly: the pilot Freemasons health study.

AIM: To present preliminary results of the pilot phase of the Freemasons Health Study. METHODS: A prospective cohort study, in which determinants of occurrence of stroke and dementia in the elderly will be investigated. RESULTS: The pilot study (n = 507) showed substantial heterogeneity in risk factor levels among participants and suggested outcome rates that would allow a study of 6000 individuals aged 65 years and over to produce statistically reliable results within a few years of follow up. Preliminary results of the pilot study suggest that the demographic (age, sex) and risk factor (namely blood pressure levels and ranges of body mass index) profile of the projected sample of the Freemasons population is similar to that of the general elderly New Zealand population. CONCLUSIONS: The pilot study confirmed that the collection of baseline data from the New Zealand Freemasons population and their spouses is feasible, and that the prevalence of major vascular risk factors in the elderly Freemasons population is similar to that of the general New Zealand population of comparable age. In addition to contributing to our understanding of the aetiology of major non-communicable diseases in the elderly, the proposed major study provides a unique opportunity to investigate the determinants of health and requirements for care in an elderly New Zealand population.

Aged↗
PubMed2002

Irampanel Boehringer Ingelheim.

The oxazole derivative, irampanel, a non-competitive AMPA receptor antagonist, is under development by Boehringer Ingelheim for the potential treatment of stroke [329079]. Phase I/IIa trials for stroke had been initiated by July 2000 [374144]. Phase II trials were ongoing in April 2001 [407163]; in April 2002, however, the drug did not appear on the company's research and development pipeline [446554], and a company spokesperson declined to confirm its current status [450591]. The compound was also originally under investigation for other neurological disorders, including epilepsy and pain [329079], although by October 1999, development was only ongoing for stroke [346080].

Animals↗