Hal Gutstein

Risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation.

Abstract Chronic atrial fibrillation (AF) in the presence or absence of rheumatic valvular heart disease is associated with an increased incidence of stroke. 1,2 We reported in a prospective study that at 27-month follow-up, echocardiographic left ventricular (LV) hypertrophy in elderly patients with systolic or diastolic hypertension was associated with an increased incidence of new atherothrombotic brain infarction. 3 We also demonstrated in a prospective study that at 3-year follow-up, risk factors for atherothrombotic brain infarction were cigarette smoking, systolic or diastolic hypertension and diabetes mellitus in elderly men and systolic or diastolic hypertension, diabetes mellitus and obesity in elderly women. 4 This report correlates in elderly patients with chronic AF the prevalence of thromboembolic (TE) stroke with the presence or absence of rheumatic mitral stenosis, mitral anular calcium, valvular aortic stenosis, systolic or diastolic hypertension, prior myocardial infarction, left atrial enlargement and LV hypertrophy.

Incidence of new thromboembolic stroke in persons 62 years and older with chronic atrial fibrillation treated with warfarin versus aspirin

OBJECTIVE: To investigate the incidence of new thromboembolic (TE) stroke in older persons with chronic atrial fibrillation treated with oral warfarin versus aspirin.

Association of mitral annular calcium with new thromboembolic stroke at 44-month follow-up of 2,148 persons, mean age 81 years

We investigated in a prospective study of 2,148 persons (mean age 81 years), the association between mitral annular calcium and new thromboembolic stroke at 44-month follow-up. Independent risk factors for new thromboembolic stroke were prior stroke (risk ratio 2.4), mitral annular calcium (risk ratio 2.6), atrial fibrillation (risk ratio 3.0), and male gender (risk ratio 1.6).

Increased plasma homocysteine is an independent predictor of new atherothrombotic brain infarction in older persons

A prospective study investigated the association of plasma homocysteine and other risk factors with the incidence of atherothrombotic brain infarction (ABI) at 31 +/- 9 month follow-up in 153 men and 347 women (mean age 81 +/- 9 years, median age 82). The stepwise Cox regression model showed that significant independent predictors of new ABI in older persons were age (risk ratio 1.060 for each 1-year increase of age), plasma homocysteine (risk ratio 1.079 for each 1 micromol/L increase), prior ABI infarction (risk ratio 3.282), current cigarette smoking (risk ratio 2.687), hypertension (risk ratio 2.965), and diabetes mellitus (risk ratio 2.015).

Three-Year Follow-Up of Risk Factors Correlated with New Atherothrombotic Brain Infarction in 708 Elderly Patients

A prospective study correlated cigarette smoking, systolic or diastolic hypertension, diabetes mellitus, hypercholesterolemia, low serum high-density lipoprotein cholesterol, hypertriglyceridemia, and obesity with development of new atherothrombotic brain infarction in 192 elderly men and 516 elderly women. Mean follow-up was 36 ± 6 months (range 19-39). New atherothrombotic brain infarction occurred in 24 of 192 men (13%) and in 63 of 516 women (12%), difference not significant. Risk factors for atherothrombotic brain infarction in elderly men were cigarette smoking (p < 0.001), systolic or diastolic hypertension (p < 0.001), and diabetes mellitus (p < 0.005). Risk factors for atherothrombotic brain infarction in elderly women were systolic or diastolic hypertension (p < 0.001), diabetes mellitus (p < 0.001), and obesity (p < 0.005).

Frequency of thromboembolic stroke in persons ≥60 years of age with extracranial carotid arterial disease and/or mitral annular calcium

Abstract Patients with extracranial internal or common carotid arterial disease have an increased incidence of ischemic stroke. 1–4 Patients with mitral annular calcium (MAC) have an increased incidence of thromboembolic stroke. 5–7 We are reporting the results from our prospective study associating extracranial internal or common carotid arterial disease and MAC with the incidence of new thromboembolic stroke at 45-month follow-up.

Association of left ventricular hypertrophy and chronic atrial fibrillation with the incidence of new thromboembolic stroke in 2,384 older persons

In a prospective study of 2,384 persons, mean age 81 years, at 44-month follow-up, new thromboembolic stroke developed in 510 of 2,384 persons (21%). The Cox regression model showed that significant independent risk factors for new thromboembolic stroke were atrial fibrillation (risk ratio 3.2), left ventricular hypertrophy (risk ratio 2.8), prior stroke (risk ratio 2.2), and male gender (risk ratio 1.2).

Association of extracranial carotid arterial disease, prior atherothrombotic brain infarction, systemic hypertension, and left ventricular hypertrophy with the incidence of new atherothrombotic brain infarction at 45-month follow-up in 1,482 older patients

Comparison of 239 older patients with 40% to 100% extracranial carotid arterial disease (ECAD) with 1,243 older patients with no significant ECAD showed a higher prevalence of systemic hypertension, left ventricular (LV) hypertrophy, and prior atherothrombotic brain infarction (ABI) and a higher incidence of new ABI in patients with ECAD than in patients without ECAD. A multivariate Cox regression model showed that independent predictors of new ABI were ECAD (risk ratio = 2.5), systemic hypertension (risk ratio = 2.3), prior ABI (risk ratio = 2.3), LV hypertrophy (risk ratio = 2.3), and male sex (risk ratio = 1.3).

Association of Plasma Renin Activity and Echocardiographic Left Ventricular Hypertrophy With Frequency of New Coronary Events and New Atherothrombotic Brain Infarction in Older Persons With Systemic Hypertension

In older hypertensive persons, male gender, prior coronary artery disease, prior atherothrombotic brain infarction (ABI), and echocardiographic left ventricular (LV) hypertrophy are independent risk factors for new coronary events; age, prior ABI, and echocardiographic LV hypertrophy are independent risk factors for new ABI. The data suggest that high plasma renin activity in hypertensive older persons is associated with a high risk of new coronary events and of new ABI through its association with echocardiographic LV hypertrophy.

Association of mitral annular calcium with prior thromboembolic stroke in older White, African-American, and Hispanic men and women.

Prior thromboembolic stroke was present in 57 of 188 white men (30%) with mitral annular calcium (MAC) and in 62 of 303 white men (20%) without MAC, in 42 of 65 African-American men (65%) with MAC and in 50 of 123 African-American men (41%) without MAC, and in 13 of 27 Hispanic men (48%) with MAC and in 21 of 58 Hispanic (36%) without MAC. Prior thromboembolic stroke was present in 164 of 614 white women (27%) with MAC and in 85 of 516 white women (16%) without MAC, in 111 of 193 African-American women (58%) with MAC and in 77 of 225 African-American women (34%) without MAC, and in 36 of 69 Hispanic women (52%) with MAC, and in 17 of 58 Hispanic women (29%) without MAC.