Epidemiology of transient ischemic attack and ischemic stroke in patients with underlying cardiovascular disease

Abstract

Summary:It is estimated that 15 to 30% of ischemic strokes are cardioembolic in origin, and that atrial fibrillation, valvular heart disease, coronary artery disease, congestive heart failure, and myocardial infarction are significant risk factors for stroke, which underscores the importance for cardiologists to understand this condition. The high incidence and substantial cost of stroke justify aggressive treatment of stroke risk factors, especially in the elderly, diabetic, and black populations, and in patients who have had an initial stroke. Antiplatelet therapy and administration of oral anticoagulants have both been shown to have a substantial impact on stroke in specified populations at risk.

From Ischemic Conditioning to ‘Hyperconditioning’: Clinical Phenomenon and Basic Science Opportunity

“…Transient ischemic attacks (TIA) occur in several hundred thousand people in the United States annually and often presage subsequent stroke (Nguyen-Huynh et al 2003;Gorelick 2004;Sonni and Thaler 2013). However, a frequently used definition of TIA ("a neurologic deficit lasting less than 24 hours that is attributed to focal cerebral or retinal ischemia" (Johnston 2002)) is not necessarily compatible with the concept that periods of conditioning ischemia should be brief; i.e., a few minutes at most.…”

Insulin Resistance and Cognitive Impairment

“…4 The finding from the Geroldi et al study that the participant subgroup with subcortical vascular features has higher rates of ATP III criteria is therefore a logical extension of the known association between cardiovascular disease and cerebrovascular disease. 8 Insulin resistance is nearly always accompanied by peripheral hyperinsulinemia, a metabolic condition with effects both related to and independent of impaired glucose uptake into muscle (the standard index of insulin resistance). Geroldi et al improve on earlier work by adding fasting hyperinsulinemia to the ATP III criteria for identification of insulin resistance.…”

Under-diagnosis of common chronic diseases: prevalence and impact on human health

“…It is estimated that 15–30% of cerebrovascular accidents are of cardioembolic origin (139). Blood glucose level abnormalities in patients with a diagnosis of IHD, and left atrial volume of 32 ml/m 2 or greater in patients without previous history of atrial fibrillation have also been associated with increased episodes of stroke and TIAs (140,141).…”