Background and purpose Dyslipidaemia is a major risk factor for ischaemic stroke and transient ischaemic attack(TIA).This study aimed to investigate the association between baseline low-density lipoprotein cholesterol...Background and purpose Dyslipidaemia is a major risk factor for ischaemic stroke and transient ischaemic attack(TIA).This study aimed to investigate the association between baseline low-density lipoprotein cholesterol(LDL-C)level,lipid-lowering treatment and short-term risk of new stroke in patients with a minor ischaemic stroke or TIA.Methods We derived data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial.Patients with a minor stroke or TIA were categorised by LDL-C level at baseline(<2.6 or≥2.6 mmol/L(100 mg/dL))and with or without lipid-lowering treatment after symptom onset.The primary outcome was a new ischaemic stroke at 3 months.The association of baseline LDL-C level,lowering treatment and outcomes were assessed.Results Among 3027 patients,2154(71.2%)patients had an initial LDL-C≥2.6 mmol/L,of which 1267(41.9%)received lipid-lowering treatment.Elevated LDL-C level was associated with a higher risk of new ischaemic stroke at 3 months in patients without lipid-lowering treatment(adj.HR=1.35,95%CI:1.19 to 1.53),but not in those with lipid-lowering treatment(adj.HR=0.99,95%CI:0.82 to 1.19)(p for interaction=0.007).Patients with LDL-C≥2.6 mmol/L had a numerically higher risk of ischaemic stroke(11.8%vs 8.0%,adj.HR=1.37,95%CI:0.96 to 1.96)in those without lipid-lowering treatment.For patients with LDL-C≥2.6 mmol/L,lipid-lowering treatment was associated with reduced risk of ischaemic stroke at 3 months(7.9%vs 11.8%;adj.HR=0.54,95%CI:0.39 to 0.75).Conclusions Elevated untreated baseline LDL-C level was associated with an increased short-term risk of ischaemic stroke among patients presenting with minor ischaemic stroke or TIA.There was potential benefit of lipid-lowering treatment in minor stroke or TIA patients with LDL-C≥2.6 mmol/L.Trial registration number NCT00979589.展开更多
Background Emergency medical services(EMS)is a critical link in the chain of stroke survival.We aimed to assess EMS use for stroke in Singapore,identify characteristics associated with EMS use and the association of E...Background Emergency medical services(EMS)is a critical link in the chain of stroke survival.We aimed to assess EMS use for stroke in Singapore,identify characteristics associated with EMS use and the association of EMS use with stroke evaluation and treatment.Methods The Singapore Stroke Registry combines nationwide EMS and public hospital data for stroke cases in Singapore.Multivariate regressions with the generalised estimating equations were performed to examine the association between EMS use and timely stroke evaluation and treatment.results Of 3555 acute ischaemic patients with symptom onset within 24 hours admitted to all five public hospitals between 2015 and 2016,68%arrived via EMS.Patients who used EMS were older,were less likely to be female,had higher stroke severity by National Institute of Health Stroke Scale and had a higher prevalence of atrial fibrillation or peripheral arterial disease.Patients transported by EMS were more likely to receive rapid evaluation(door-to imaging time≤25 min 34.3%vs 11.1%,OR=2.74(95%CI 1.40 to 5.38))and were more likely to receive intravenous tissue plasminogen activator(tPA,22.8%vs 4.6%,OR=4.61(95%CI 3.52 to 6.03)).Among patients treated with tPA,patients who arrived via EMS were more likely to receive timely treatment than self-transported patients(door-to needle time≤60 min 52.6%vs 29.4%,OR=2.58(95%CI 1.35 to 4.92)).Conclusions EMS use is associated with timely stroke evaluation and treatment in Singapore.Seamless EMS-Hospital stroke pathways and targeted public campaigns to advocate for appropriate EMS use have the potential to improve acute stroke care.展开更多
Objective Subarachnoid haemorrhage(SAH)accounts for 3%of all strokes,and is associated with significant morbidity and mortality.There is growing evidence implicating apolipoprotein E(apoE)in mediating adaptive anti-in...Objective Subarachnoid haemorrhage(SAH)accounts for 3%of all strokes,and is associated with significant morbidity and mortality.There is growing evidence implicating apolipoprotein E(apoE)in mediating adaptive anti-inflammatory and neuroprotective responses following ischaemic and traumatic brain injury.In the current study,we test the efficacy of a small apoE mimetic peptide,CN-105 in a murine model of SAH.Methods Mice subjected to SAH received repeated intravenous injections of CN-105 every 12 hours for 3 days,with the first dose given 2 hours after injury.Daily functional outcomes were assessed by rotarod and neurological severity score.Haemorrhage grade and cerebral vascular diameters were measured at 5 days post-SAH.Cerebral microgliosis,neuronal degeneration and survival were analysed at 5 and 35 days post-SAH,respectively.results CN-105 reduces histological evidence of inflammation,reduces vasospasm and neuronal injury and is associated with improved long-term behavioural outcomes in a murine model of SAH.Conclusions Given its favourable pharmacokinetic profile,central nervous system penetration and demonstration of clinical safety,CN-105 represents an attractive therapeutic candidate for treatment of brain injury associated with SAH.展开更多
基金supported by grants from National Key R&D Program of China(2018YFC1312903)grants from the National Natural Science Foundation of China(81971091,81870905,U20A20358)+1 种基金Beijing Hospitals Authority Youth Programme(QML20190501)grants from Beijing Municipal Science and Technology Commission(D171100003017002,Z181100001818001).
文摘Background and purpose Dyslipidaemia is a major risk factor for ischaemic stroke and transient ischaemic attack(TIA).This study aimed to investigate the association between baseline low-density lipoprotein cholesterol(LDL-C)level,lipid-lowering treatment and short-term risk of new stroke in patients with a minor ischaemic stroke or TIA.Methods We derived data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial.Patients with a minor stroke or TIA were categorised by LDL-C level at baseline(<2.6 or≥2.6 mmol/L(100 mg/dL))and with or without lipid-lowering treatment after symptom onset.The primary outcome was a new ischaemic stroke at 3 months.The association of baseline LDL-C level,lowering treatment and outcomes were assessed.Results Among 3027 patients,2154(71.2%)patients had an initial LDL-C≥2.6 mmol/L,of which 1267(41.9%)received lipid-lowering treatment.Elevated LDL-C level was associated with a higher risk of new ischaemic stroke at 3 months in patients without lipid-lowering treatment(adj.HR=1.35,95%CI:1.19 to 1.53),but not in those with lipid-lowering treatment(adj.HR=0.99,95%CI:0.82 to 1.19)(p for interaction=0.007).Patients with LDL-C≥2.6 mmol/L had a numerically higher risk of ischaemic stroke(11.8%vs 8.0%,adj.HR=1.37,95%CI:0.96 to 1.96)in those without lipid-lowering treatment.For patients with LDL-C≥2.6 mmol/L,lipid-lowering treatment was associated with reduced risk of ischaemic stroke at 3 months(7.9%vs 11.8%;adj.HR=0.54,95%CI:0.39 to 0.75).Conclusions Elevated untreated baseline LDL-C level was associated with an increased short-term risk of ischaemic stroke among patients presenting with minor ischaemic stroke or TIA.There was potential benefit of lipid-lowering treatment in minor stroke or TIA patients with LDL-C≥2.6 mmol/L.Trial registration number NCT00979589.
文摘Background Emergency medical services(EMS)is a critical link in the chain of stroke survival.We aimed to assess EMS use for stroke in Singapore,identify characteristics associated with EMS use and the association of EMS use with stroke evaluation and treatment.Methods The Singapore Stroke Registry combines nationwide EMS and public hospital data for stroke cases in Singapore.Multivariate regressions with the generalised estimating equations were performed to examine the association between EMS use and timely stroke evaluation and treatment.results Of 3555 acute ischaemic patients with symptom onset within 24 hours admitted to all five public hospitals between 2015 and 2016,68%arrived via EMS.Patients who used EMS were older,were less likely to be female,had higher stroke severity by National Institute of Health Stroke Scale and had a higher prevalence of atrial fibrillation or peripheral arterial disease.Patients transported by EMS were more likely to receive rapid evaluation(door-to imaging time≤25 min 34.3%vs 11.1%,OR=2.74(95%CI 1.40 to 5.38))and were more likely to receive intravenous tissue plasminogen activator(tPA,22.8%vs 4.6%,OR=4.61(95%CI 3.52 to 6.03)).Among patients treated with tPA,patients who arrived via EMS were more likely to receive timely treatment than self-transported patients(door-to needle time≤60 min 52.6%vs 29.4%,OR=2.58(95%CI 1.35 to 4.92)).Conclusions EMS use is associated with timely stroke evaluation and treatment in Singapore.Seamless EMS-Hospital stroke pathways and targeted public campaigns to advocate for appropriate EMS use have the potential to improve acute stroke care.
基金This work was partially supported by DOD contract CDMRP#W81XWH-16-C-0142.
文摘Objective Subarachnoid haemorrhage(SAH)accounts for 3%of all strokes,and is associated with significant morbidity and mortality.There is growing evidence implicating apolipoprotein E(apoE)in mediating adaptive anti-inflammatory and neuroprotective responses following ischaemic and traumatic brain injury.In the current study,we test the efficacy of a small apoE mimetic peptide,CN-105 in a murine model of SAH.Methods Mice subjected to SAH received repeated intravenous injections of CN-105 every 12 hours for 3 days,with the first dose given 2 hours after injury.Daily functional outcomes were assessed by rotarod and neurological severity score.Haemorrhage grade and cerebral vascular diameters were measured at 5 days post-SAH.Cerebral microgliosis,neuronal degeneration and survival were analysed at 5 and 35 days post-SAH,respectively.results CN-105 reduces histological evidence of inflammation,reduces vasospasm and neuronal injury and is associated with improved long-term behavioural outcomes in a murine model of SAH.Conclusions Given its favourable pharmacokinetic profile,central nervous system penetration and demonstration of clinical safety,CN-105 represents an attractive therapeutic candidate for treatment of brain injury associated with SAH.
