Annette Fromm

Comparison between Ischemic Stroke Patients <50 Years and ≥50 Years Admitted to a Single Centre: The Bergen Stroke Study.

Introduction. Young adults are likely to differ from old patients concerning cerebral infarction. Methods. We compared characteristics of patients aged under and above 50 years, admitted to the Department of Neurology with cerebral infarction between 2006 and 2009, based on prospective registration. Investigation followed one common protocol for both groups. Results and Discussion. One hundred patients (8.2%) were <50 years old, and the proportion of males was higher in this group (72% versus 55.8%, P = .002). Young stroke patients are more often current smokers (44.1% versus 23.6%, P < .001). Common causes for stroke in the young were cervical artery dissection (18% versus 0.6%, P < .001) and cardiac embolism due to disorders other than atrial arrhythmias (18% versus 5.5%, P < .001). Among the old, atrial fibrillation and flutter dominated (29.1% versus 5%, P < .001). Stroke severity and location did not differ. Old patients more often suffered from pneumonia (10.6% versus 2%, P < .003) and urinary tract infection (14.6% versus 2%, P = .001). Conclusions. Males dominate, and current smoking is more common in the young. Cervical artery dissection and nonarrhythmic heart disorders are frequent causes among young patients, while traditional risk factors dominate the old. Stroke severity is similar, but old patients seem more exposed for infectious complications.

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study.

Age dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population.

A vascular approach to mild amnestic cognitive impairment: a pilot study

Mild cognitive impairment (MCI) is a subtle memory disorder not matching criteria for dementia. There is evidence for vascular comorbidity in several types of dementia. We hypothesized that neurovascular workup would detect a high degree of vascular disease in patients with MCI.

Atherosclerosis in Trial of Org 10172 in Acute Stroke Treatment Subtypes among Young and Middle-Aged Stroke Patients: The Norwegian Stroke in the Young Study

BACKGROUND Ischemic stroke patients subtyped as of undetermined cause (SUC) usually outnumber those with determined cause subtypes. Etiological stroke classifications may lead to neglect of parallel, noncausative findings. Atherosclerosis progresses over decades and is associated with high morbidity and mortality in young stroke patients in long-term follow-up studies. We compared the prevalence of carotid atherosclerosis in all TOAST subtypes among young patients with acute ischemic stroke. METHODS We investigated 150 patients aged 15-60 years with documented acute ischemic stroke, and 84 controls free of cardiovascular disease. Stroke etiology was classified according to TOAST criteria. Carotid intima-media thickness (cIMT) measurements were obtained from 12 standardized multiangle measurements in the common carotid artery, carotid bifurcation, and internal carotid artery. RESULTS The causes of stroke were 5.3% large-artery atherosclerosis (LAA), 26.7% cardioembolism, 21.3% small-artery occlusion (SAO), 10% stroke of other determined cause, and 36.7% stroke of undetermined cause (SUC). cIMT was increased in patients with LAA (1.56 mm, P = .002), SAO (1.11 mm, P = .006), and SUC (1.10 mm, P = .004) compared to controls (cIMT 0.86 mm). Segmental cIMT distribution differed across stroke subtypes, age groups, and sexes. CONCLUSIONS Atherosclerotic disease is prevalent in the majority of young and middle-aged ischemic stroke patients, requiring determined investigation and aggressive treatment of modifiable risk factors.

Covariates of non-dipping and elevated night-time blood pressure in ischemic stroke patients: the Norwegian Stroke in the Young Study*

Abstract Abnormal night-time blood pressure (BP) reduction is associated with increased cardiovascular risk in hypertension. Little is known about the prevalence and covariates of night-time BP reduction in ischemic stroke patients. Clinic and ambulatory BP measurements were recorded in 268 stroke survivors aged 15–60 years. The degree of night-time dipping was calculated from the difference between day-time and night-time mean BP, and defined as non-dipping if < 10%. Aortic stiffness was derived from carotid–femoral pulse-wave velocity (PWV) by applanation tonometry and carotid intima–media thickness (cIMT) by ultrasound. A non-dipping pattern was found in 38%. Non-dippers had higher PWV, mean cIMT and night-time BP, and included more patients with history of hypertension, diabetes and high for age PWV compared to dippers (all p < 0.05). In multivariate logistic regression analyses, non-dipping was associated with high for age PWV [odds ratio (OR) = 2.28; 95% confidence interval (CI) 1.06–4.92, p < 0.05] independent of history of hypertension and other confounders, while elevated night-time BP was associated with increased cIMT (OR = 3.83; 95% CI 1.01–14.50, p < 0.05) independent of non-dipping status, male gender, obesity, antihypertensive treatment and high for age PWV. In conclusion, in the Norwegian Stroke in the Young Study, non-dipping BP pattern was common and associated with increased aortic stiffness.

Early Vascular Aging in Young and Middle-Aged Ischemic Stroke Patients: The Norwegian Stroke in the Young Study

Background Ischemic stroke survivors have high risk of cardiovascular morbidity and mortality even at young age, suggesting that early arterial aging is common among such patients. Methods We measured aortic stiffness by carotid-femoral pulse wave velocity (PWV) in 205 patients (69% men) aged 15–60 years with acute ischemic stroke in the prospective Norwegian Stroke in the Young Study. High for age carotid-femoral PWV was identified in the reference normogram. Results Patients were on average 49±10 years old, 34% had a history of hypertension and 37% had metabolic syndrome (MetS). In the total study population, higher PWV was associated with history of hypertension (β = 0.18), higher age (β = 0.34), systolic blood pressure (BP) (β = 0.28) and serum creatinine (β = 0.18) and lower high-density lipoprotein (HDL) cholesterol (β = –0.10, all p<0.01) in multivariate linear regression analysis (multiple R2 = 0.42, p<0.001). High for age PWV was found in 18% of patients. In univariate analyses, known hypertension was associated with a 6-fold, MetS with a 4-fold and presence of carotid plaque with a 3.7-fold higher risk for high for age PWV (all p<0.01). In multiple logistic regression analysis higher systolic BP (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.02–1.06; p<0.01), history of hypertension (OR 3.59; 95% CI 1.52–8.51; p<0.01), low HDL cholesterol (OR 3.03; 95% CI 1.00–9.09; p = 0.05) and higher serum creatinine (OR 1.04; 95% CI 1.01–1.06; p<0.01) were associated with high for age PWV. Conclusions Higher PWV is common in younger and middle-aged ischemic stroke patients and associated with a clustering of classical cardiovascular risk factors. ClinicalTrials.gov NCT01597453

Prevalence and covariates of masked hypertension in ischemic stroke survivors: the Norwegian Stroke in the Young Study.

BackgroundMasked hypertension (MHT) is characterized by normal clinic blood pressure (BP), but elevated ambulatory BP has been associated with a higher prevalence of cardiovascular organ damage. MethodsWe assessed the prevalence and characteristics of MHT in 298 ischemic stroke patients aged 15–60 years. High-normal office BP was considered present if systolic BP was 130–139 mmHg and/or diastolic BP was 85–89 mmHg. Arterial damage was defined as increased pulse wave velocity measured by applanation tonometry and/or mean common carotid intima-media thickness more than 0.9 mm measured by ultrasound. ResultsMHT was found in 12% of patients. In multivariable logistic regression analysis, MHT patients were characterized by higher BMI [odds ratio (OR) 1.09; 95% confidence interval (CI) 1.03–1.16], high-normal office BP (OR 2.30; 95% CI 1.26–4.21), and higher serum triglycerides (OR 1.32; 95% CI 1.01–1.47, all P<0.05) in the total study population. Compared with normotensive patients, MHT was characterized by a higher prevalence of high-normal office BP (OR 2.05; 95% CI 1.08–3.90), obesity (OR 2.67; 95% CI 1.31–5.47), and arterial damage (OR 2.87; 95% CI 1.46–5.66, all P<0.05). Compared with patients with sustained hypertension, MHT was associated with a lower prevalence of arterial damage (OR 0.48; 95% CI 0.23–0.99, P=0.05) despite a higher prevalence of high-normal office BP and comparable ambulatory BP values. ConclusionAmong young and middle-aged ischemic stroke patients, MHT was found in 12% and associated with high-normal office BP, obesity, and more prevalent arterial damage compared with normotensive patients, underscoring the importance of identification of MHT in these patients.

Decline of arterial cerebral infarction among young women: the Bergen Stroke Study

Objective: To assess the frequency of females and males aged ≤30 years with cerebral infarction in two different time periods. Methods: All patients aged ≤30 years with arterial cerebral infarction in 1988–1997 and 2006–2010 admitted to Haukeland University Hospital in Bergen, Norway, were included. Risk factors and etiology were assessed. Results: Between 1988 and 1997, 16 females and 7 males had cerebral infarction, whereas 0 females and 13 males had cerebral infarction in 2006–2010 (P = 0.0001). The incidence of cerebral infarction in females was significantly lower between 2006 and 2010 than between 1988 and 1997 (P = 0.007). Conclusion: Our findings suggest that the frequency of cerebral infarction among young females has dropped significantly during recent years.

A Family History of Stroke Is Associated with Increased Intima-Media Thickness in Young Ischemic Stroke - The Norwegian Stroke in the Young Study (NOR-SYS).

Background and Purpose Positive family history (FH+) of cardiovascular disease (CVD) is a risk factor for own CVD. We aimed to analyze the effect of different types of FH (stroke, coronary heart disease (CHD), peripheral artery disease (PAD) on carotid intima-media thickness (cIMT) in young and middle-aged ischemic stroke patients. Methods First-degree FH of CVD was assessed in ischemic stroke patients ≤ 60y using a standardized interview. Carotid ultrasound was performed and far wall cIMT in three carotid artery segments was registered, representing the common carotid (CCA-IMT), carotid bifurcation (BIF-IMT) and the internal carotid artery (ICA-IMT). Measurements were compared between FH+ and FH negative groups and stepwise backward regression analyses were performed to identify factors associated with increased cIMT. Results During the study period 382 patients were enrolled, of which 262 (68%) were males and 233 (61%) reported FH of CVD. Regression analyses adjusting for risk factors revealed age as the most important predictor of cIMT in all segments. The association between FH+ and cIMT was modified by age (p = 0.014) and was significant only regarding ICA-IMT. FH+ was associated with increased ICA-IMT in patients aged < 45y (p = 0.001), but not in patients ≥ 45y (p = 0.083). The association with ICA-IMT was present for a FH of stroke (p = 0.034), but not a FH+ of CHD or PAD. Conclusions FH of stroke is associated with higher ICA-IMT in young ischemic stroke patients. Subtyping of cardiovascular FH is important to investigate heredity in young ischemic stroke patients. Trial Registration ClinicalTrials.gov NCT01597453

Impact of Diabetes Mellitus on 1867 Acute Ischemic Stroke Patients. A Bergen NORSTROKE Study

Objective: Our aim was to compare the clinical characteristics including risk factors, comorbidities, short-term outcome and long-term mortality in acute ischemic stroke patients with or without diabetes mellitus. Methods: This study includes all consecutive patients with acute ischemic stroke admitted to the Stroke Unit, Department of Neurology, Haukeland University Hospital between February 2006 and January 2012. The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity on admission. Short-term outcome was determined by the modified Rankin scale (mRS), NIHSS, and Barthel index on day 7 after stroke onset. First emergency readmission < 12 months after discharge was registered. Survival state was obtained by consulting the official population registry. Results: In total, 1867 patients of which 283 (15%) patients had diabetes mellitus. Relative frequency of diabetes mellitus according to age showed and inverse U-shape with highest frequency at 75-80 years for males, whereas the frequency was independent of age among females. More males than females had diabetes mellitus. Patients with diabetes mellitus more often had myocardial infarction, angina pectoris, hypertension (all P<.001), and higher total risk factor burden (P<.001). Patients with diabetes mellitus had worse short-term outcome (P<0.001) and long-term mortality was increased. Patients with diabetes mellitus had more frequent first emergency readmission within 90 days (P=0.044). Conclusions: Stroke patients with diabetes mellitus have significantly more traditional risk factors. Short-term outcome and long-term mortality were worse. Relative frequencies of diabetes mellitus and age differed between males and females.