Stroke is a devastating, neurological dysfunction due to brain blood supply disturbance. It is responsible for increasingly high rate of mortality and disability worldwide. This thesis comprises two original studies involving 868 patients at risk of ischemic stroke and/or hemorrhagic stroke. The first study investigated aspirin’s effect among patients with intracranial hemorrhage. Unlike Caucasians which hemorrhagic strokes account for 10-15% of all strokes; in Chinese, intracranial hemorrhages strike up to 35%. After such, anti-platelet agent like aspirin is often avoided for fear of recurrent intracranial hemorrhages, despite compelling indications. However, clinical data is limited. In this single-centered observational study, we included 440 consecutive Chinese patients with a first spontaneous intracranial hemorrhage surviving the first month performed during 1996-2010. 56 patients (12.7%) of these 440 patients were prescribed aspirin after intracranial hemorrhage (312 patient-aspirin years). After a mean follow-up of 62.2 ± 1.8 months, 47 patients had recurrent intracranial hemorrhage(10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have higher risk of recurrent intracranial hemorrhage compared with those without (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years and hypertension as independent predictors for recurrent intracranial hemorrhage. In a subgroup analysis: the incidence of combined vascular events including recurrent intracranial hemorrhage, ischemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than without (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). Implications of the results: despite having a substantial risk for recurrent intracranial hemorrhage, post-intracranial hemorrhage ones are at risk for thrombotic vascular events and management goal should thus focus on ameliorating overall cardiovascular risk instead of preventing recurrent intracranial hemorrhage. Hence, thrombo-prophylaxis should still be considered. The second study investigated the relation between premature atrial complexes and new-onset atrial fibrillation together with other cardiovascular events. Premature atrial complexes though taken as benign phenomenon, are common in patients with underlying conditions such as coronary heart disease, chronic rheumatic heart disease. While prompt management of atrial fibrillation may prevent ischemic stroke, atrial fibrillation is often unfound until ischemic stroke occurs. In this study, 428 patients without atrial fibrillation but complained of palpitations, dizziness or syncope were recruited. 107 patients with >100 premature atrial complexes/day were defined to have frequent premature atrial complexes. After a mean follow-up of 6.1 ±1.3 years, 31 patients (29%) with frequent premature atrial complexes developed atrial fibrillation compared with 29 patients (9%) with premature atrial complexes?100/day (p<0.01). Cox regression analysis revealed: frequent premature atrial complexes, age>75 years and coronary artery disease were independent predictors. In secondary endpoint (ischemic stroke, congestive heart failure, and death), patients with frequent premature atrial complexes were more at risk than those without (34.5% vs. 19.3%) (Hazard ratio: 1.95, 95% confidence interval: 1.37-3.50, p=0.001). Cox regression analysis showed: age> 75 years, coronary artery disease and frequent premature atrial complexes were independent predictors. These permit early identification of high risks patients of new atrial fibrillation and other events, thus promoting appropriate preventive treatment. / published_or_final_version / Medicine / Master / Master of Philosophy

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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Medicine / Master / Doctor of Medicine

Traditional indicators of cardiovascular disease (CVD) risk may not be appropriate for Asian Indians. We designed a cross-sectional study of body fat distribution, apoB/apoA1 ratio and adipokines of Northern Indians compared to Caucasians to determine if there is a different relationship between these parameters. Indian (men: n = 54; women n = 28) and Caucasian (men: n= 32; women, n = 51) subjects were recruited who were between the ages of 20 and 60 years. Subjects were excluded if they had a history of CVD or were taking lipid lowering medications. Body fat percentage (BF%) was measured using bioelectrical impedance analysis. Indian subjects had a substantially higher waist-to-hip ratio (WHR) ratio than Caucasian subjects (men: 0.93 +/- 0.01 vs. 0.86 +/- 0.01, p &lt; 0.001; women: 0.88 +/- 0.01 vs. 0.76 +/- 0.01, p &lt; 0.0001). Interestingly, while WHR correlated strongly with BF% in Caucasians (men: r = 0.63 p = 0.0002; women: r = 0.74, p &lt; 0.0001, respectively) there was no correlation in Indians (men: r = 0.22, ns; women: r = 0.23, ns). The regression lines for WHR vs. BF% of Indians compared to Caucasians was significantly different (men p = 0.02, women p = 0.002). A similar pattern of correlation was seen with WHR and BMI. In addition, Indian men and women had a higher apoB/A1 ratio than Caucasians: the most powerful lipoprotein measure of CVD risk (men: 0.84+/-0.04 vs. 0.66+/-0.04, p=0.001; women: 0.70+/-0.04 vs. 0.56+/-0.03, p = 0.003, respectively). Leptin levels were higher and adiponectin levels in lower in the Indian men and women. Hypothetically, these alterations in body composition, apoB/apoA1 and adipokines could be due to alterations in adipocyte number.

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

Access to abstract permanently restricted to Ball State community only / Access to thesis permanently restricted to Ball State community only / School of Physical Education, Sport, and Exercise Science

Access to abstract permanently restricted to Ball State community only. / Access to thesis permanently restricted to Ball State community only. / School of Physical Education, Sport, and Exercise Science

The relationships of serum cholesterol, blood pressure and cigarette smoking with certain chronic diseases were investigated in a prospective study among more than 9,000 middle-aged adults in urban Shanghai. At baseline, the mean serum cholesterol was 4.2 mmol/l, 14 per cent of the participants had definite hypertension, and 61 per cent of males and 7 per cent of females were regular smokers. During 8-13 years of follow-up, 620 deaths were recorded. 231 (37%) of the deaths were ascribed to cardiovascular disease, including 44 (7%) from CHD and 152 (25%) from stroke. Cancer caused 274 deaths (44%), of which 66 deaths (11%) were from lung cancer, 63 (10%) from stomach cancer and 54 deaths (9%) from liver cancer. Other causes accounted for 115 deaths (19%), 29 (5%) of which were from chronic liver disease, and 31 (5%) from chronic obstructive pulmonary disease. In this study, there was a strong positive and apparently independent relationship of serum cholesterol level to CHD death (z=3.47, 2P<0.001). Within the range of usual serum cholesterol studied (about 3.8-4.7 mmol/l), there was no evidence of any apparent "threshold". After appropriate adjustment for the "regression dilution" bias, a 4% difference in usual cholesterol was associated with a 21% (95% confidence interval 9-35%) difference in the risk of CHD death. There was no significant relationship of serum cholesterol with total stroke mortality, or with total cancer mortality. The 79 deaths due to liver cancer or other chronic liver diseases were inversely related to cholesterol concentration at baseline. This inverse association appears to be secondary to prolonged hepatitis B virus infection, which accounts for most of the deaths from liver disease in China and which chronically lowers blood cholesterol. There was a strong positive relationship between blood pressure and risk of death from stroke and CHD. Within the range of usual blood pressure studied (SBP: 117-161 mmHg; DBP:75-101 mmHg), there was no evidence of any apparent threshold. After appropriate adjustment for the "regression dilution" bias, a 10 mmHg difference in usual SBP was associated with a 67% (95% Cl 52-83%) difference in the risk of stroke deaths, and with a 44% (95% confidence interval 21- 73%) difference in the risk of CHD death; a 7 mmHg difference in usual DBP was associated with a 124% (95% Cl 96-155%) difference in the risk of stroke deaths, and with a 58% (95% Cl 22-105%) difference in the risk of CHD deaths. Cigarette smoking was significantly associated with deaths from any disease. There was a strong positive relationship between cigarette smoking and risk of all cancer deaths, and specifically cancer of the lung and cancer of the upper aerodigestive tract. The relative risk of lung cancer for a current smoker was 3.5 (95% Cl 1.8-7.0; 2P<0.001), and among the male population 63% of lung cancers were directly attributed to the smoking. The relative risk of upper aero-digestive cancer death for regular smokers was 3.4 (95% Cl 1.1-10.5; 2P<0.05). The risk of chronic obstructive lung disease was also significantly related to smoking, with a relative risk in a smoker of 2.2 (95% Cl 1.1-4.4; 2P<0.05). In the present population, smokers had a 60% excess risk of deaths from total stroke compared with nonsmokers (z=2.40, 2P<0.05).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.