Risk factors for recurrent ischemic stroke in Turkey

çelik, yahya; Yalçın, Murat; EKUKLU, Galip; YALCIN, ESRA

Risk factors for recurrent ischemic stroke in Turkey

Esra YALÇIN, (Samsun Devlet Hastanesi, Samsun, Türkiye)

Murat YALÇIN, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Aile Hekimliği Anabilim Dalı, Samsun, Türkiye)

Yahya ÇELİK, (Trakya Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, Edirne, Türkiye)

Galip EKUKLU (Trakya Üniversitesi, Tıp Fakültesi, Halk Sağlığı Anabilim Dalı, Edirne, Türkiye)

Trakya Üniversitesi Tıp Fakültesi Dergisi

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Yıl: 2008 Cilt: 25 Sayı: 2 Sayfa Aralığı: 117 - 123 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Risk factors for recurrent ischemic stroke in Turkey

Öz:

Objectives: The aim of the study is to determine the risk factors for recurrent ischemic stroke. Patients and Methods: We compared the risk factors in 186 recurrent ischemic stroke patients (94 males, 92 females; mean age 66.85±11.21 years; range 20-95 years) with 300 first-ever stroke patients (control group) among 1150 ischemic stroke patients who had been treated in Neurology Department of Trakya University Medical Faculty over a period of three years.Results: The recurrence rate was 16.1%. Within the recurrent patients, 89.7% had hypertension, 32.3% had atrial fibrillation, 24.4% had diabetes mellitus, 15.6% had transient ischemic attack, and 57.5% had several types of heart diseases. The most frequent recurrence etiology was embolic according to TOAST criteria (35.5%). Transient ischemic attack (OR= 2.98; 95% CI 1.54-5.76), hypertension (OR= 1.96; 95% CI 1.11-2.64) and atrial fibrillation (OR= 1.74; 95% CI 1.44-2.66) were found as the independent risk factors. The mean of the modified Rankin scores of the study group at their last charge were significantly higher than that of the control group.Conclusion: Our findings emphasize the importance of the consistent anticoagulation therapy for patients with atrial fibrillation and close blood pressure control in patients with hypertension.

Anahtar Kelime: Ischemia Turkey Stroke Risk Factors Recurrence

Konular: Genel ve Dahili Tıp

Türkiye'de reküren iskemik inme üzerine etkili risk faktörleri

Öz:

Amaç: Bu çalışmada reküren iskemik inmede risk faktörleri belirlendi. Hastalar ve Yöntemler: Üç yıllık dönemde Trakya Üniversitesi Tıp Fakültesi Hastanesi Nöroloji Kliniği’ne başvuran toplam 1150 hasta içinden reküren inme geçiren 186 hasta (94 erkek, 92 kadın; ort. yaş 66.85±11.21; dağılım 20-95) ilk iskemik inmesini geçiren 300 hasta ile risk faktörleri açısından karşılaştırıldı.Bulgular: Reküren inme oranı %16.1 idi. Reküren inme grubunda hastaların %89.7’sinde hipertansiyon, %32.3’ünde atrial fibrilasyon, %24.4’ünde diabetes mellitus, %15.6’sında geçici iskemik atak ve %57.5’inde değişik kalp hastalıklarının olduğu gözlendi. Reküren inmenin en sık görülen etyolojik nedeni TOAST sınıflamasına göre kardiyoembolizmdi (%35.5). Geçici iskemik atak (OR= 2.98; %95 CI 1.54-5.76), hipertansiyon (OR= 1.96; %95 CI 1.11-2.64) ve atrial fibrilasyon (OR= 1.74; %95 CI 1.44-2.66) reküren inme için bağımsız risk faktörü olarak bulundu. Hasta grubu ile kontrol grubu modifiye Rankin skoru için karşılaştırıldığında hasta grubunda bu skorun daha kötü olduğu izlendi.Sonuç: Bizim bulgularımız hipertansif hastalarda kan basıncı kontrolünün, atriyal fibrilasyonlu hastalarda ise etkin antikoagülasyonun reküren inmeyi önlemede önemli olduğunu göstermiştir.

Anahtar Kelime: Risk faktörleri Tekrarlama İskemi Türkiye İnme

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1) World Health Organization. The fact Sheet no: 310. The Top Ten Causes of Death. Avaible from: http:// www.who.int/mediacentre/factsheets/fs310.pdf
2) Samsa GP, Bian J, Lipscomb J, Matchar DB. Epidemiology of recurrent cerebral infarction: a medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost. Stroke 1999; 30:338-49.
3) Sobel E, Alter M, Davanipour Z, Friday G, McCoy R, Levitt LP, et al. Stroke in the Lehigh Valley: combined risk factors for recurrent ischemic stroke. Neurology 1989;39:669-72.
4) Hier DB, Foulkes MA, Swiontoniowski M, Sacco RL, Gorelick PB, Mohr JP, et al. Stroke recurrence within 2 years after ischemic infarction. Stroke 1991;22:155-61.
5) Sacco RL, Wolf PA, Kannel WB, McNamara PM. Survival and recurrence following stroke. The Framingham study. Stroke 1982;13:290-5.
6) Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology 1998;50:208-16.
7) Goldstein LB, Adams R, Becker K, Furberg CD, Gorelick PB, Hademenos G, et al. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001;32:280-99.
8) Jørgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology 1997;48:891-5.
9) Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke 1994;25:333-7.
10) Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989;20:1407-31.
11) Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
12) Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke 1988;19:1497-1500.
13) Wolf PA, Clagett GP, Easton JD, Goldstein LB, Gorelick PB, Kelly-Hayes M, et al. Preventing ischemic stroke in patients with prior stroke and transient ischemic attack: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 1999;30:1991-4.
14) Messerli FH, Hanley DF Jr, Gorelick PB. Blood pressure control in stroke patients: what should the consulting neurologist advise? Neurology 2002;59:23-5.
15) Irie K, Yamaguchi T, Minematsu K, Omae T. The J-curve phenomenon in stroke recurrence. Stroke 1993;24:1844-9.
16) Sacco RL, Shi T, Zamanillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994;44:626-34.
17) Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991;54:1044-54.
18) PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358:1033-41.
19) Chalmers J. Trials on blood pressure-lowering and secondary stroke prevention. Am J Cardiol 2003;91:3G-8G.
20) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993;342:1255-62.
21) Hankey GJ. Warfarin-Aspirin Recurrent Stroke Study (WARSS) trial: is warfarin really a reasonable therapeutic alternative to aspirin for preventing recurrent noncardioembolic ischemic stroke? Stroke 2002;33:1723-6.
22) Sudlow M, Thomson R, Thwaites B, Rodgers H, Kenny RA. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet 1998;352:1167-71.
23) Kolominsky-Rabas PL, Sarti C, Heuschmann PU, Graf C, Siemonsen S, Neundoerfer B, et al. A prospective community-based study of stroke in Germany-the Erlangen Stroke Project (ESPro): incidence and case fatality at 1, 3, and 12 months. Stroke 1998;29:2501-6.
24) Yamamoto H, Bogousslavsky J. Mechanisms of second and further strokes. J Neurol Neurosurg Psychiatry 1998;64:771-6.

APA	YALCIN E, Yalçın M, çelik y, EKUKLU G (2008). Risk factors for recurrent ischemic stroke in Turkey. , 117 - 123.
Chicago	YALCIN ESRA,Yalçın Murat,çelik yahya,EKUKLU Galip Risk factors for recurrent ischemic stroke in Turkey. (2008): 117 - 123.
MLA	YALCIN ESRA,Yalçın Murat,çelik yahya,EKUKLU Galip Risk factors for recurrent ischemic stroke in Turkey. , 2008, ss.117 - 123.
AMA	YALCIN E,Yalçın M,çelik y,EKUKLU G Risk factors for recurrent ischemic stroke in Turkey. . 2008; 117 - 123.
Vancouver	YALCIN E,Yalçın M,çelik y,EKUKLU G Risk factors for recurrent ischemic stroke in Turkey. . 2008; 117 - 123.
IEEE	YALCIN E,Yalçın M,çelik y,EKUKLU G "Risk factors for recurrent ischemic stroke in Turkey." , ss.117 - 123, 2008.
ISNAD	YALCIN, ESRA vd. "Risk factors for recurrent ischemic stroke in Turkey". (2008), 117-123.

APA	YALCIN E, Yalçın M, çelik y, EKUKLU G (2008). Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Dergisi, 25(2), 117 - 123.
Chicago	YALCIN ESRA,Yalçın Murat,çelik yahya,EKUKLU Galip Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Dergisi 25, no.2 (2008): 117 - 123.
MLA	YALCIN ESRA,Yalçın Murat,çelik yahya,EKUKLU Galip Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Dergisi, vol.25, no.2, 2008, ss.117 - 123.
AMA	YALCIN E,Yalçın M,çelik y,EKUKLU G Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Dergisi. 2008; 25(2): 117 - 123.
Vancouver	YALCIN E,Yalçın M,çelik y,EKUKLU G Risk factors for recurrent ischemic stroke in Turkey. Trakya Üniversitesi Tıp Fakültesi Dergisi. 2008; 25(2): 117 - 123.
IEEE	YALCIN E,Yalçın M,çelik y,EKUKLU G "Risk factors for recurrent ischemic stroke in Turkey." Trakya Üniversitesi Tıp Fakültesi Dergisi, 25, ss.117 - 123, 2008.
ISNAD	YALCIN, ESRA vd. "Risk factors for recurrent ischemic stroke in Turkey". Trakya Üniversitesi Tıp Fakültesi Dergisi 25/2 (2008), 117-123.