The health benefits of raw garlic intake has been extensively studied, but little is known about the biological effects of aged garlic consumption. A randomized, placebo-controlled, parallel-arm, double-blinded trial involving 41 hypercholesterolemic individuals was conducted to simultaneously examine and compare the blood lipid lowering and antioxidant effects after acute and extended exposures to aged and raw garlic supplements (1080 mg daily). Aged and raw garlic did not affect blood lipid concentrations in these hypercholesterolemic participants after acute and 13-week supplementation. The plasma and urinary F-isoprostanes concentrations were significantly decreased after 13 weeks of aged garlic treatment. Aged garlic supplementation over 13 weeks also significantly decreased serum lipid hydroperoxide concentration and myeloperoxidase activity. Raw garlic treatments did not affect the F-isoprostanes concentrations in blood plasma and urine, and lipid hydroperoxides in blood sera. Acute effects on the measured parameters were absent for both garlic treatments. In separate in vitro experiments, aqueous methanolic extract of aged garlic inhibited F-isoprostanes formation and myeloperoxidase activity in freshly isolated human neutrophils to a greater extent than the raw garlic extract and S-allylcysteine at equivalent dosing concentrations. The aged garlic preparation was found to contain significantly higher total phenolic and S-allylcysteine contents than the raw garlic precursor. Our data showed that supplementation with aged garlic, not its raw garlic precursor, reduced oxidative stress and alleviated lipid peroxidation, possibly via the inhibition of myeloperoxidase. The differential antioxidant actions of the aged and raw garlic may be related to their different total phenolic contents and, to a lesser extent, their S-allylcysteine contents.

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Stroke biomarkers open a window of opportunity for clinicians and researchers to apply insights gained from advances in stroke biology to clinical practice. A wider use of stroke biomarkers into the clinical setting can facilitate decision-making during acute management of stroke complications and, through development of risk prediction models, guide improving the long-term outcomes of stroke patients. The focus of this chapter is on elaborating upon clinical scenarios where biomarkers could aid in clinical decision-making to avert and/or manage stroke complications such as hemorrhagic transformation, malignant cerebral infarction and early neurologic deterioration. Furthermore, biomarkers could also serve to improve stroke diagnosis by ruling out its mimics, better understanding stroke mechanisms, identifying high-risk patients for adverse outcomes and identifying those who might benefit from prolonged cardiac monitoring for the detection of atrial fibrillation. Stroke biomarkers could provide an additional investigative tool to assist clinicians who encounter difficult clinical scenarios when managing patients with an ischemic stroke.

Introduction: Diabetes increases the risk of ischaemic stroke especially among Asians. This study aims to investigate contemporaneous long-term cardiovascular outcomes of ischaemic stroke patients with diabetes in a multi-ethnic Asian cohort. Methods: Consecutive patients with ischaemic stroke were recruited from the National University Hospital, Singapore. Data on age, gender, ethnicity, risk factors (including diabetes status and body mass index [BMI]), stroke severity and mechanisms were collected. These patients were followed up until the day of the first cardiovascular event or July 2016, whichever was earlier. The primary endpoint was the time from enrolment to the first occurrence of a composite of cerebrovascular and coronary artery events. Results: Between July 2011 and December 2013, 720 patients (mean age 60.6 years, 71% men, 43% with diabetes, median National Institute Health Stroke Severity scale 2) were enrolled and followed up. A total of 175 cardiovascular events occurred during a median follow-up of 3.25 years (6.90 events per 1,000 person-month), comprising 163 cerebrovascular and 42 coronary artery events. The adjusted hazard ratio of diabetes was 1.50 (95% CI 1.08–2.10). In a multivariable Cox proportional hazards model, Malay and Indian ethnicities, BMI <23kg/m2 and a prior diagnosis of diabetes were identified as independent predictors of recurrent cardiovascular events. Conclusion: Our study provides quantitative data on the event rates of ischaemic stroke patients with diabetes. These findings provide insights on stroke predictors in a multi-ethnic Asian population, which may have implications in the design of future interventional studies. Keywords: Asian, body mass index, cardiovascular, stroke phenotype

Background: Women have generally lower levels of uric acid compared with men, yet their long-term prognostic impact is unclear in ischemic stroke patients. This study aims to investigate the significance of serum uric acid in relation to 5-year recurrent vascular events and mortality in ischemic stroke patients. Methods: Consecutive patients with acute ischemic stroke were recruited from the National University Hospital, Singapore, between January 2011 and December 2012. Demographic, risk factor, stroke etiology and severity information were compared with the development of vascular events (defined as stroke, myocardial infarction, and vascular-related death) and all-cause mortality. Blood samples were collected during their acute hospitalization; in a subset of patients, repeated samples were collected 3-6 months later. Uric acid was measured in serum using the Cobas c111 analyzer (Roche, Germany). The effects of uric acid on vascular events and death were evaluated by Cox proportional hazard models. Results: A total of 531 ischemic stroke patients (mean age 59.2 years; 72% men; mean uric acid 357 mmol/l [men], 319 mmol/l [women]) were followed for a mean of 3 years. During this period, 136 vascular events (72% stroke and transient ischemic attack, 18% myocardial infarction and 10% vascular-related death) and 51 deaths were recorded. In women, significant associations were observed between uric acid levels and vascular-related deaths and all-cause deaths (adjusted hazard ratios 1.01 [95% CI 1.00-1.01; p =0.008] and 1.01 [1.00-1.01; p =0.001] respectively); no association was observed with vascular events. By contrast, no significant association was observed between vascular-related events and deaths in men. 176 patients had uric acid levels repeated. Overall, there was an increase in uric acid levels (326 vs 360 mmol/l; p<0.001, paired t-test) approximately 4 months following stroke onset. These changes, however, did not correlate with subsequent development of vascular and death events in men and women. Conclusions: In women, uric acid levels predict long-term vascular death and all-cause mortality in ischemic stroke patients. The sex-specific differences in the association between uric acid and stroke outcomes warrant further investigations.