22. European Stroke Conference 276 Etiology of stroke and risk factors Increased subclnical morphological and functional impairments if hypertension is combined with hyperlipidemia L. Csiba1, K.R. Kovács2, Z. Bajkó3, C.C Szekeres4, K. Csapó5, L. Olah6, S. Molnar7, D. Bereczki8, M.T. Magyar9, L. Kardos10, P. Soltész11, D. Czuriga12, A. Burai13 Department of Neurology, Debrecen, HUNGARY1, Department of Neurology, Debrecen, HUN-GARY2, Mures; County Clinical Emergency Hospital, Targu Mures, ROMANIA3, Mures; County Clinical Emergency Hospital, Targu Mures, ROMANIA4, Department of Neurology, Debrecen, HUNGARY5, Department of Neurology, Debrecen, HUNGARY6, Department of Neurology, So-pron, HUNGARY7, Department of Neurology, Budapest, HUNGARY8, Department of Neurology, Debrecen, HUNGARY9, Independent statistician, Debrecen, HUNGARY10, Department of Internal Medicine, Debrecen, HUNGARY11, Department of Cardiology, Debrecen, HUNGARY12, Independent Psychologist, De-brecen, 432 © 2013 S. Karger AG, Basel Scientific Programme HUNGARY13 Objective: hypertension and hyperlipidemia are stroke risk-factors. We examined the combined ef-fects of hypertension and hyperlipidemia on the characteristics of the arterial wall and on cognitive functions of symptom-free risk patients with normal brain imaging. Methods: 75 hypertensives and 95 controls were investigated. Four subgroups were created:con-trols, hypertensives, hyperlipidemics and hypertensives with hyperlipidemia. Measurements of carotid intima-media thickness, arterial stiffness parameters (brachial augmentation index:AiX and brachial pulse wave velocity:PWV) and a battery of neuropsychological tests (12 tests for attention, memory, reaction speed etc.) were performed. Results: IMT was significantly higher in the HT group compared to controls (0.60±0.01 vs. 0.53±0.01 mm; P=0.0002) or LDL groups (0.60±0.01 vs. 0.55±0.01 mm; P=0.0173). A further in-crease in the IMT value was found if hypertension was associated with elevated LDL–C levels. Sum of standardized neuropsychological tests scores (SSTS), which comprises the results of all (12) tests: the difference between the four groups did not reach statistical significance during unadjusted com-parison, although it was remarkable between the CON and HT or HT+LDL groups (1.83±0.61 vs. 0.12±0.66 (P=0.0593) or 0.43±1.07 (P=0.0645) for CON and HT or HT+LDL, respectively). Arterial stiffness:significantly increased augmentation index (Aix) was in the HT and LDL groups compared to CON (31.29±3.15 vs. 13.98±4.96 % (P=0.0097) or 16.03±4.12 % (P=0.0039) for CON and HT or LDL, respectively).Comparison between the HT+LDL and CON groups resulted in an even greater difference (9.51±5.49 vs. 31.29±3.15 %; P=0.0004). Pulse wave velocities: signifi-cantly higher values were observed in association with hypertension (9.89±0.28 vs. 8.53±0.22 m/s; P<0.0001). Conclusions: subclinical changes of vascular wall and cognitive performance are al-ready present in recently diagnosed hypertensive patients. Combination of hyperlipidemia and hy-pertension resulted in more severe impairments, therefore early and intensive treatment might be crucial to prevent a stroke. 277 Etiology of stroke and risk factors Gradually increased stroke rate by 1% per year in type 2 diabetic Chinese patients with as-ymptomatic cerebrovascular disease X.Y. Chen1, J.G. Duan2, A. Lau3, A. Wong4, G.N. Thomas5, B. Tomlinson6, J.C.N. Chan7, K.S. Wong8 the Chinese University of Hong Kong, Shatin, HONG-KONG1, Tianjin Pinghu Hospital, Tian-jin, CHINA2, the Chinese University of Hong Kong, Shatin, HONG-KONG3, Institute of Education, Hong Kong, Shatin, HONG-KONG4, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UNITED KINGDOM5, the Chinese University of Hong Kong, Shatin, HONG-KONG6, the Chinese University of Hong Kong, Shatin, HONG-KONG7, the Chinese University of Hong Kong, Shatin, HONG-KONG8 Background: Stroke is a leading cause of mortality in Chinese population as the population ages. Diabetic melli-tus is a well-known risk factor of stroke. In this cohort study of type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease, stroke occurrence was recorded from 1994-2012 and the contribution of intracranial large artery disease was explored. Methods: It was a hospital clinic based cohort study recruiting 2,197 type 2 diabetic patients. The presence of MCA stenosis was determined by transcranial Doppler and stroke onset was collected by regular follow up. Cox proportional hazards regression was used to determine the contribution of MCA ste-nosis to the occurrence of stroke, adjusted by age and hypertension. Results: Stroke was recorded in 372 patients (in hemorrhagic stroke in 19 patients). The rate of stroke by year was: 23 patients (1.0%) with stroke in the 1st year, 18 patients(0.8%) in the 2nd year, 21(1.0%) in the 3rd, 31(1.4%) in the 4th, 27(1.2%) in the 5th, 25(1.1%) in the 6th, 26(1.2%) in the 7th, 33(1.5%) in the 8th, 30(1.4%) in the 9th, 16(0.7%) in the 10th, 20(0.9%) in the 11th, 31(1.4%) in the 12th, 27(1.2%) in the 13th, 18(0.8%) in the 14th, 13(0.6%) in the 15th, and 13(0.6%) after 15 years from baseline assessment. Gradually increased rate was detected at around 1% per year. There were 120 patients (5.5%) occurred stroke in the first five years, 130 patients (5.9%) in the second five years and 122 patients (5.6%) in the third five years and up to 18 years. Cox regression showed MCA stenosis was an independent risk factor of stroke in type 2 diabetic patients (p=0.005, ExpB: 1.465, 95% Confidential interval: 1.124-1.909) after adjusting age and hy-pertension. To categorize stroke occurrence to three period by five years, we found that MCA steno-sis only predicted stroke occurrence in the second five years (p=0.030, ExpB: 1.617, 95% Confiden-tial interval: 1.049-2.494). Conclusion: In type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease, the event of stroke may occur gradually with years. MCA stenosis may play an important role in the occurrence of stroke from 5-10 years.
Karger_ESC London_2013
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