Mitchell S V Elkind | Search PubMed

PubMed2003

Stroke in the elderly.

Stroke is one of the oldest but least understood diseases, and it is one of the major public health problems facing the elderly. Recent epidemiological investigations have found that the incidence of stroke has been underestimated by about 50%, and that the burden of disease is highest in minority populations. Recent clinical and basic neuroscience research indicates that stroke is neither unpredictable nor irreversible. Many risk factors for stroke are readily identifiable, and evidence-based treatment may be used to reduce the likelihood of stroke among those at risk. Rapid diagnosis and evaluation of stroke and transient ischemic attack and their treatment, including surgery, anticoagulation, antiplatelet and other medical therapies, reduce the chance of recurrence. More aggressive treatment of blood pressure, even among patients who are not necessarily hypertensive, may also reduce the risk of future strokes. Once ischemic stroke has occurred, emergent therapy using thrombolysis may significantly reduce disability, even among the elderly. This review presents an update on definitions of stroke and its subtypes, stroke epidemiology, and the results of recent studies of stroke prevention and acute treatment.

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PubMed2002

Leukocyte count is associated with aortic arch plaque thickness.

BACKGROUND AND PURPOSE: Leukocyte count has been associated with cardiovascular and cerebrovascular disease, including carotid plaque thickness, in several studies. We hypothesized that white blood cell count is associated with aortic arch plaque thickness (AAPT). METHODS: Leukocyte count was measured in randomly selected stroke-free community participants undergoing transesophageal echocardiography. AAPT was measured for each subject and dichotomized into <4 and > or =4 mm (thick plaque). Multivariate linear and logistic regression was used to calculate the effect of leukocyte count on AAPT after adjustment for potential confounding factors. Mean age of the 145 participants was 68.5+/-8.3 years; 43.5% were women; 15.9% were white; 31.7% were black; and 49.0% were Hispanic. RESULTS: Mean leukocyte count was 5.88+/-1.76x10(9)/L. Each unit increase in leukocyte count was associated with a mean 0.28-mm increase in AAPT (P=0.0036). After adjustment for other atherosclerosis risk factors, including age, sex, hypertension, diabetes, hyperlipidemia, and smoking, the relationship persisted (mean increase in AAPT, 0.24 mm; P=0.0064). Thirty-five participants (24.1%) had AAPT > or =4 mm. Mean leukocyte count among those with thick plaque was significantly higher than among those with plaque <4 mm (6.54+/-1.60 versus 5.65+/-1.76x10(9)/L, respectively; P=0.009). Each unit increase in leukocyte count was associated with an increased risk of thick plaque (adjusted odds ratio, 1.38; 95% CI, 1.05 to 1.79). The relationships were similar for men and women and for those <70 or > or =70 years of age. CONCLUSIONS: Leukocyte count is associated with AAPT and is specifically correlated with AAPT > or =4 mm, a degree of thickening associated with increased stroke risk. These findings are consistent with current hypotheses regarding the inflammatory or infectious etiology of risk of atherosclerosis and stroke.

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