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London, United Kingdom 2013 14 Etiology of stroke and risk factors Predictive factors for severe aortic arch atheroma – Fukuoka Stroke Registry – S. Mezuki1, S. Fujimoto2, T. Matsuki3, J. Jinnouchi4, T. Ishitsuka5, T. Kitazono6 Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN1, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN2, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN3, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN4, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN5, Department of Medicine and Clini-cal Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN6 Background & Purpose: Some previous reports revealed that aortic arch atheroma of 4mm or more could be an embolic source of ischemic stroke. Transesophageal echocardiography (TEE) can pro-vide detailed information regarding aortic arch atheroma. However, TEE is somewhat invasive and is not so easy to be performed as any other ultrasonography is. Therefore, we investigated predictive factors for severe aortic arch atheroma (SAAA). Methods: Among the consecutive 6246 patients who were admitted to the 7 stroke centers within 7 days after the symptom onset, 998 patients with ischemic strokes who underwent TEE were includ-ed in this study. We compared the differences in clinical backgrounds, risk factors, prior drug uses and laboratory findings between patients with and without SAAA of 4mm or more in diameter. Results: SAAA was observed in 501 (50.2%) patients. Patients with SAAA were older than those without SAAA. Male, history of smoking, hypertension, dyslipidemia, hemodialysis, diabetes melli-tus, peripheral arterial disease, history of ischemic stroke and ischemic heart disease were more fre-quent, and initial creatinine, uric acid, HOMA-R and APTT values were higher in patients with than without SAAA. Initial estimated GFR and HDL-cholesterol values were lower in patients with than without SAAA. Maximum intima-media thickness (max IMT) of the right carotid artery was thicker in patients with than without SAAA. On the multivariate logistic regression analysis, age (OR 1.10, 95%CI 1.06-1.14), history of smoking (OR 2.35, 95%CI 1.23-4.45), and max IMT (OR 1.53, 95%CI 1.08-2.19) had positive associations and estimated GFR value (OR 0.98, 95%CI 0.96-0.99) had a negative association with SAAA. With regard to the ROC curve analysis, the most accurate cut-off values for predicting SAAA were 67 years in age, 65.1 ml/min/1.73m2 in estimated GFR, and 1.60mm in max IMT. Conclusions: High-risk cases for SAAA can be predicted by using age, history of smoking, estimat-ed GFR, and max IMT. TEE should be performed especially in such high-risk cases to evaluate aor-tic arch atheroma. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 227 13 Etiology of stroke and risk factors Vitamin D Deficiency is Independently Associated with Ischemic Stroke in an Asian Case-con-trol Study M.S.H. Tan1, L.P. Talabucon2, E.Y. Ng3, E.K. Tan4, W.L. Lee5, D.A. De Silva6 Duke-NUS Graduate Medical School, Singapore, SINGAPORE1, National Neuroscience Insti-tute, Singapore, SINGAPORE2, National Neuroscience Institute, Singapore, SINGAPORE3, Nation-al Neuroscience Institute, Singapore, SINGAPORE4, National Neuroscience Institute, Singapore, SINGAPORE5, National Neuroscience Institute, Singapore, SINGAPORE6 Background: The association of low vitamin D levels with increased stroke risk has been suggest-ed in some longitudinal population studies, but not in others. There is a paucity of literature on ethnic Asians particularly case-control data on the vitamin D-stroke risk relationship. We studied the association of serum 25-dihydroxyvitamin D (25(OH)D) and ischemic stroke in a prospective case-control study of ethnic Asians. Methods: We recruited 271 ethnic Chinese and Indian acute ischemic stroke patients who were matched to 271 non-stroke controls for age within 5 years, gen-der and ethnicity on a one-to-one basis. Blood was taken within 2 weeks of stroke onset to minimize post-stroke confounders and serum 25(OH)D levels was measured blinded to clinical data. Vitamin D deficiency was defined as 25(OH)D levels (<20μg/L) Results: Mean 25(OH)D levels are lower in stroke cases than controls (24.0 vs 27.7μg/L; p<0.001). The median difference of 25(OH)D lev-els between stroke cases and controls was 16% (95% CI -17% to 64%) equivalent to 3.8μg/L. The prevalence of vitamin D deficiency was higher in stroke vs control cohorts (36 vs 23%; p=0.001). In regression analysis adjusting for age, hypertension, diabetes, hyperlipidemia and smoking, stroke patients were more likely to have vitamin D deficiency compared to controls (OR 1.71 95% CI 1.15 to 2.56). There was no interaction between gender and the association of 25(OH)D levels with ischemic stroke (p=0.3). Conclusion: This is the first case-control study showing an independent as-sociation of ischemic stroke and 25(OH)D levels measured shortly after onset to reflect pre-stroke levels, contributing to the evidence of vitamin D deficiency as a novel stroke risk factor. The high prevalence of vitamin D deficiency and association with ischemic stroke in ethnic Asians suggest a potential role for vitamin D screening and supplementation in primary stroke prevention.


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