Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage

Nichols, Linda; Stirling, CM; Otáhal, Petr; Stankovich, Jim; Gall, Seana

doi:10.1016/j.jstrokecerebrovasdis.2017.09.055

Cited by 28 publications

(22 citation statements)

References 30 publications

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“…Our ndings are largely consistent with those of other New Zealand (13-15) and international (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) studies that have also found higher rates of major bleeds (total, gastrointestinal or intracranial) in non-Whites compared with Whites and with increasing socioeconomic deprivation. In these studies, populations were not de ned according to their history of CVD and AF, and there was adjustment for a limited number of variables, if any.…”

Section: Discussionsupporting

confidence: 90%

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Tse

Grey

Harwood

et al. 2020

Preprint

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Background: Antithrombotic medication (antiplatelets and anticoagulants) reduce the risk of cardiovascular disease (CVD), but with the disadvantage of increasing bleeding risk. Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables. Methods: Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 Māori, the indigenous people of New Zealand) aged 30-79 years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n=15,212), (2) CVD and no AF (n=43,790), (3) no CVD or AF (n=429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine whether ethnicity and socioeconomic deprivation are independent predictors of major bleeds in different cardiovascular risk groups . Results: In all three subgroups (AF, CVD, no CVD/AF), Māori (adjHR 1.63 [1.39-1.91], 1.24 [1.09-1.42], 1.57 [95% CI 1.45-1.70], respectively), Pacific people (adjHR 1.90 [1.58-2.28], 1.30 [1.12-1.51], 1.62 [95% CI 1.49-1.75], respectively) and Chinese people (adjHR 1.53 [1.08-2.16], 1.15 [0.90-1.47], 1.13 [95% CI 1.01-1.26], respectively) were at increased risk of a major bleed compared to Europeans, although for Chinese people the effect did not reach statistical significance in the CVD subgroup. Compared to Europeans, Māori and Pacific peoples were generally at increased risk of all bleed types (gastrointestinal, intracranial and other bleeds). An increased risk of intracranial bleeds was observed among Chinese and Other Asian people and, in the CVD and no CVD/AF subgroups, among Indian people. Increasing socioeconomic deprivation was also associated with increased risk of a major bleed in all three subgroups (adjHR 1.07 [95% CI 1.02-1.12, 1.07 [1.03-1.10], 1.10 [1.08-1.12], respectively, for each increase in socioeconomic deprivation quintile). Conclusion: Ethnicity and socioeconomic status should be considered in bleeding risk assessments to guide the use of antithrombotic medication for the management of AF and CVD. Primary Funding Source: The Health Research Council of New Zealand

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Section: Discussionsupporting

confidence: 90%

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Tse

Grey

Harwood

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In the study group, the vast majority -73% -were women. Compared to other studies, this is a consistent result, which indicates that women have an increased risk of developing an aneurysm of the brain, including the unruptured one, although the reasons for this are unknown [23,24]. The average age of the examined people was 53, which is consistent with other studies that show the average age of 50 years for the global population with diagnosed intracranial aneurysm [25].…”

Section: Discussionsupporting

confidence: 89%

Evaluation of the Results of Therapeutic Management of Patients Treated Endovascularly for Cerebral Aneurysm

Jabłońska

Bielewicz

2020

PNIN

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Introduction. Intracranial aneurysm is the most common type of brain vascular defects. Their treatment is based on excluding vascular malformation from circulation. Endovascular methods are being performed more and more often. Aim. Evaluation of the results of therapeutic management of patients treated endovascularly for cerebral aneurysm. Material and Methods. The study involved 49 patients with a diagnosed brain aneurysm qualified for endovascular treatment (embolization, stent). Standardized research tools were used: GCS, H&H, GOS, SWF. The examination was carried out twice on one patient: on the day of admission and discharge from the ward. The collected material was statistically processed. Results. Most of the respondents were women — 74%. Almost 61% of patients had non-cracked aneurysm. In 41% embolization was performed, and in 39% embolization with a stent. The aneurysm site was associated with the GCS score at discharge χ²(8) = 15.64; p < 0.05; V = 0.40. Marital status was associated with SWF in the assessment 2: χ²(9) = 19.18; p < 0.05; V = 0.36. The state of consciousness of the patients had no significant impact on the scope of their functioning: GCS Z = 0.42; p = 0.675 and SWF Z = 0.40; p = 0.689. Conclusions. The clinical condition of patients with cerebral aneurysm varies depending on the stage of treatment, admission mode and type of aneurysm. Only the professional situation and marital status of the examined persons influenced the functional state and the final assessment of patients’ treatment. (JNNN 2020;9(1):3–11) Key Words: brain aneurysm, assessment, endovascular methods

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“…Subarachnoid hemorrhage (SAH) is a devastating and life-threatening cerebrovascular disease with high morbidity and mortality and remains a serious problem worldwide. This stroke subtype is up to 10%–15% fatality in patients before they reach to hospital (Nichols et al, 2018 ). Although increasingly early diagnosis with brain imaging and neurosurgical interventions are available, 8%–20% of the victims were permanently disabled (van Gijn et al, 2007 ; Nieuwkamp et al, 2009 ).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of Heat Shock Protein 90 by 17-AAG Reduces Inflammation via P2X7 Receptor/NLRP3 Inflammasome Pathway and Increases Neurogenesis After Subarachnoid Hemorrhage in Mice

Zuo

Wang

Liao

et al. 2018

Front. Mol. Neurosci.

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Subarachnoid hemorrhage (SAH) is a life-threatening cerebrovascular disease that usually has a poor prognosis. Heat shock proteins (HSPs) have been implicated in the mechanisms of SAH-associated damage, including increased inflammation and reduced neurogenesis. The aim of this study was to investigate the effects of HSP90 inhibition on inflammation and neurogenesis in a mouse model of experimental SAH induced by endovascular surgery. Western blotting showed HSP90 levels to be decreased, while neurogenesis, evaluated by 5-bromo-2’-deoxyuridine (BrdU) immunohistochemistry, was decreased in the hippocampuses of SAH mice. SAH also induced pro-inflammatory factors such as interleukin-1β (IL-1β), capase-1 and the NLRP3 inflammasome. However, intraperitoneal administration of the specific HSP90 inhibitor 17-allylamino-17-demethoxygeldanamycin (17-AAG) reduced the levels of HSP90, NLRP3, ASC, caspase-1 and IL-1β, while increasing the levels of brain-derived neurotrophic factor and doublecortin (DCX), as well as the number of BrdU-positive cells in SAH mice. In addition, 17-AGG improved short- and long-term neurobehavioral outcomes. The neuroprotective and anti-inflammatory effects of 17-AGG were reversed by recombinant HSP90 (rHSP90); this detrimental effect of HSP90 was inhibited by the specific P2X7 receptor (P2X7R) inhibitor A438079, indicating that SAH-induced inflammation and inhibition of neurogenesis were likely mediated by HSP90 and the P2X7R/NLRP3 inflammasome pathway. HSP90 inhibition by 17-AAG may be a promising therapeutic strategy for the treatment of SAH.

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Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage

Cited by 28 publications

References 30 publications

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Risk of Major Bleeding by Ethnicity and Socioeconomic Deprivation among 488,107 People in Primary Care: A Cohort Study

Evaluation of the Results of Therapeutic Management of Patients Treated Endovascularly for Cerebral Aneurysm

Inhibition of Heat Shock Protein 90 by 17-AAG Reduces Inflammation via P2X7 Receptor/NLRP3 Inflammasome Pathway and Increases Neurogenesis After Subarachnoid Hemorrhage in Mice

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