Stroke subtypes: Type 1 and 2 women face greater risk
Filed under: Type 1, Type 2, Research, Complications
Just out in the new issue of Diabetes Care: a report that diabetic women are more at risk for the various stroke subtypes. (Today is just a day for bad health news, I guess. See my previous blog on trauma injuries.) Stroke, as you may already know, is where blood supply to the brain is restricted or cut off. The study's authors tracked the progress of 116,316 women through middle age during the period 1976 to 2002. That's a lotta women... They found the women with diabetes were at a higher risk for stroke, generally: four times higher than that of the general population for women with Type 1 diabetes, and twice as high for women with Type 2 diabetes.
That people with diabetes face a higher risk of stroke is not new. What is new? This study also looked at stroke subtypes and relative risk for women with and without diabetes for each of those subtypes. Some results: ischemic stroke (caused by a blood clot to the brain) risk was 6.3 times higher for T1 diabetics, 2.3 times higher for T2 diabetics. The risk for large-artery infarction and lacunar stroke was similar. The study also concluded that while Type 1 diabetic women face a higher risk of hemorrhagic stroke (where bleeding occurs in the brain or between the brain and the skull), Type 2 women did not.
This study was funded by the National Institutes of Health.
Read more about strokes and learn how to recognize signs of stroke by visiting some of the excellent Web-based resources out there. A good starting point is InteliHealth's section on stroke or visit the National Stroke Association's website. You could save someone's life!
[RESEARCH] Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
Objective To determine the effect of calcium supplementation on myocardial infarction, stroke, and sudden death in healthy postmenopausal women.
Design Randomised, placebo controlled trial.
Setting Academic medical centre in an urban setting in New Zealand.
Participants 1471 postmenopausal women (mean age 74): 732 were randomised to calcium supplementation and 739 to placebo.
Main outcome measures Adverse cardiovascular events over five years: death, sudden death, myocardial infarction, angina, other chest pain, stroke, transient ischaemic attack, and a composite end point of myocardial infarction, stroke, or sudden death.
Results Myocardial infarction was more commonly reported in the calcium group than in the placebo group (45 events in 31 women v 19 events in 14 women, P=0.01). The composite end point of myocardial infarction, stroke, or sudden death was also more common in the calcium group (101 events in 69 women v 54 events in 42 women, P=0.008). After adjudication myocardial infarction remained more common in the calcium group (24 events in 21 women v 10 events in 10 women, relative risk 2.12, 95% confidence interval 1.01 to 4.47). For the composite end point 61 events were verified in 51 women in the calcium group and 36 events in 35 women in the placebo group (relative risk 1.47, 0.97 to 2.23). When unreported events were added from the national database of hospital admissions in New Zealand the relative risk of myocardial infarction was 1.49 (0.86 to 2.57) and that of the composite end point was 1.21 (0.84 to 1.74). The respective rate ratios were 1.67 (95% confidence intervals 0.98 to 2.87) and 1.43 (1.01 to 2.04); event rates: placebo 16.3/1000 person years, calcium 23.3/1000 person years. For stroke (including unreported events) the relative risk was 1.37 (0.83 to 2.28) and the rate ratio was 1.45 (0.88 to 2.49).
Conclusion Calcium supplementation in healthy postmenopausal women is associated with upward trends in cardiovascular event rates. This potentially detrimental effect should be balanced against the likely benefits of calcium on bone.
Trial registration Australian Clinical Trials Registry ACTRN 012605000242628.
A lost bankcard gets a faster response than stroke symptoms?
Filed under: Daily news
Maybe if we all took our health as seriously as we do our money we'd be better off. The recent results of a study, which can only be described as shameful, show that the majority of people would react faster to a stolen bankcard than they would to the symptoms of a stroke. Like heart attacks, it seems many people don't know what the symptoms of a stroke are and don't really want to believe it's happening to them. Of the people surveyed, those taking the longest to seek medical help were people over 65 -- the very people at the highest risk.Symptoms of a stroke include facial weakness, arm weakness, and speech problems. Strokes can cause immediate and devastating brain damage, with every minute critical to recovery, so if you even suspect a stroke please act immediately.
Living near traffic can cause a stroke
Filed under: Prevention, Research
There's getting to be less and less rural countryside on this planet as our population expands and our cities grow -- and unfortunately it's not doing good things for our health. Studies show that living near high traffic urban areas has a directly negative affect on heart health by increasing a person's risk for developing atherosclerosis and therefore also increasing a person's risk for heart disease and stroke. The biggest risk is for people living within 50 meters (or 160 feet) of major traffic. They suffer a 63% greater risk of heart problems compared to people living 200 meters or farther from traffic.But what do they consider major traffic? New York City I'm sure, but what about living near an interstate in Iowa?
[RESEARCH] Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial
Objectives To determine the effects of two computer based decision aids on decisional conflict and mode of delivery among pregnant women with a previous caesarean section.
Design Randomised trial, conducted from May 2004 to August 2006.
Setting Four maternity units in south west England, and Scotland.
Participants 742 pregnant women with one previous lower segment caesarean section and delivery expected at ≥37 weeks. Non-English speakers were excluded.
Interventions Usual care: standard care given by obstetric and midwifery staff. Information programme: women navigated through descriptions and probabilities of clinical outcomes for mother and baby associated with planned vaginal birth, elective caesarean section, and emergency caesarean section. Decision analysis: mode of delivery was recommended based on utility assessments performed by the woman combined with probabilities of clinical outcomes within a concealed decision tree. Both interventions were delivered via a laptop computer after brief instructions from a researcher.
Main outcome measures Total score on decisional conflict scale, and mode of delivery.
Results Women in the information programme (adjusted difference –6.2, 95% confidence interval –8.7 to –3.7) and the decision analysis (–4.0, –6.5 to –1.5) groups had reduced decisional conflict compared with women in the usual care group. The rate of vaginal birth was higher for women in the decision analysis group compared with the usual care group (37% v 30%, adjusted odds ratio 1.42, 0.94 to 2.14), but the rates were similar in the information programme and usual care groups.
Conclusions Decision aids can help women who have had a previous caesarean section to decide on mode of delivery in a subsequent pregnancy. The decision analysis approach might substantially affect national rates of caesarean section.
Trial Registration Current Controlled Trials ISRCTN84367722.
[RESEARCH] Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study
Objective To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections.
Design Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark.
Setting Obstetric department and neonatal department of a university hospital in Denmark.
Participants All liveborn babies without malformations, with gestational ages between 37 and 41 weeks, and delivered between 1 January 1998 and 31 December 2006 (34 458 babies).
Main outcome measures Respiratory morbidity (transitory tachypnoea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation).
Results 2687 infants were delivered by elective caesarean section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks’ gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks’ gestation (3.0, 2.1 to 4.3), and 39 weeks’ gestation (1.9, 1.2 to 3.0). The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios: a fivefold increase was found at 37 weeks (5.0, 1.6 to16.0). These results remained essentially unchanged after exclusion of pregnancies complicated by diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation.
Conclusion Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased with decreasing gestational age.
No Benefit Found for Post-Stroke Tight Glucose Control
Filed under: Type 1, Type 2, Childhood, Adult Onset, Research
British researchers have found that tight glucose control during hospitalization for a stroke may not improve survivalThe study involved 933 patients enrolled within 24 hours of a stroke who had glucose in the range of 6.0 to 17 mmol/l. Participants received saline solution or continuous glucose, potassium, insulin infusions to reduce their blood glucose. Patients were monitored every two hours with glucose adjusted if needed every eight hours. The researchers found that both treatment and placebo groups had improvement in glucose levels. The treatment group had an overall mean 0.57 mmol/l reduction in glucose over 24 hours while glucose levels also fell spontaneously with simple saline hydration. There was also no difference in the secondary outcome of disability. There was a significant reduction in systolic blood pressure in the treatment group. A researcher noted, "In the majority of patients, treatment with a simple saline infusion will correct mild to moderate hyperglycemia."
The saline and glucose relationship is similar to the way the noninvasive glucose monitors measure blood sugar (aka Glucowatch)., This relationship between sodium and glucose in the blood moves inverse. When your sugar levels are elevated, your sodium is down. When you force sodium into your blood, your sugar is suppressed. Doctors must proceed with caution in light of this study. When it comes to aggressively lowering glucose, especially after a trauma, it could be more harmful than helpful.
What's the deal with aspirin and strokes?
Filed under: Drugs, Daily news, Women Heart Health, Men Heart Health, Aging Heart Health
It's a pretty well-known belief that taking an aspirin a day will reduce your risk of stroke. Actually, it's pretty much regarded as a proven fact, although this thinking might have to be changed as it's also being said that Aspirin may in fact increase your chance of a stroke. According to experts, the risks associated with Aspirin outweigh the benefits, though the risks of taking Aspirin are not specified. Nonetheless, I think it's bad practice to take any sort of drug every day unless ordered by your doctor.This just goes to show that you can't believe everything you read or hear, even if it is regarded as fact.
Combo surgery may put you at risk
Filed under: Research, Surgery
Published in yesterday's issue of Neurology, the journal of the American Academy of Neurology (typically, this can be found on the shelf next to Maxim and FHM in Border's), researchers have found that combining heart bypass surgery and carotid endarterectomy may increase the chance of death or postoperative stroke.
The study of discharge data from over 650,000 patients who had been admitted into hospitals in the U.S. for coronary bypass artery surgery or carotid endarterectomy from 1993 to 2002. It was discovered that patients who underwent both of these procedures at the same time had a 38 percent greater chance of stroke or death after the operation than did patients who had the coronary artery bypass surgery alone.
Doctors involved in this study now question whether if there is any benefit to performing these two procedures during the same hospitalization. They hope to arrive at an answer with a greater degree of certainty after holding further clinical trials.
[RESEARCH] Sex ratio and time to pregnancy: analysis of four large European population surveys
Objective To test whether the secondary sex ratio (proportion of male births) is associated with time to pregnancy, a marker of fertility.
Design Analysis of four large population surveys.
Setting Denmark and the United Kingdom.
Participants 49 506 pregnancies.
Main outcome measure Secondary sex ratio.
Results No association was found between the sex ratio and time to pregnancy and no discernible trend was found for sex ratio with time to pregnancy, either within individual datasets or in the pooled analysis. The odds ratios were 0.97 (95% confidence interval 0.90 to 1.04) for contraceptive failures, 1.01 (0.96 to 1.05) for time to pregnancy of 2-4 months, 1.02 (0.97 to 1.08) for 5-10 months, 0.98 (0.93 to 1.03) for 11 months or more, and 0.88 (0.74 to 1.06) for fertility treatment, with 0-1 months as the reference category.
Conclusion No association was found between the secondary sex ratio and time to pregnancy.