Arterial disorders, stroke risk

Cardiovascular and cerebrovascular disorders associated with lipid metabolism disturbance and atherosclerosis represent major risk factors for dementia (3,25,59). Atherosclerosis is the primary cause of heart disease and stroke in which genetic and environmental factors converge (553). More than 90% of patients older than 70-80 yr with dementia show signs of atherosclerosis in their arteries and a clear cerebrovascular component in their dementia process. It is very likely that pure AD is practically absent in octogenarians, in whom the prevalent diagnosis is vascular or mixed dementia (3,25,59), in which the APOE-4 allele also accumulates (18-20,554). 

Schmahmann JD (2003). Vascular syndromes of the thalamus. Stroke 34 2264-2278 Schulz UG, Rothwell PM (2001). Major variation in carotid bifurcation anatomy a possible risk factor for plaque development Stroke 32 2522-2529 Scott BL, Jankovic J (1996). Delayed-onset progressive movement disorders after static brain lesions. Neurology 46 68-74 Wardlaw JM, Merrick MV, Ferrington CM et al. (1996). Comparison of a simple isotope method of predicting likely middle cerebral artery occlusion with transcranial Doppler ultrasound in acute ischaemic stroke. Cerebrovascular Diseases 6 32-39 Wardlaw JM, Lewsi SC, Dennis MS etal. (1999). Is it reasonable to assume a particular embolic source from the type of stroke Cerebrovascular Diseases 9(Supp 1) 14... 

Hemodynamic changes after the topical ocular use of beta-blockers sometimes include only small reductions in heart rate and resting pulse rate and an insignificant reduction in blood pressure. However, patients with cardiovascular disorders, especially those with an irregular heart rate and dysrhythmias, are certainly at risk (SEDA-4, 339). Bradycardia, cardiac arrest, heart block, hypotension, palpitations, syncope, and cerebral ischemia and stroke can occur (356). Rebound tachycardia has been reported after withdrawal of ophthalmic timolol (88,357). Continuous 24-hour monitoring of blood pressure has shown that beta-blocker eye-drops for glaucoma can increase the risk of nocturnal arterial hjq>otension (358). 

Aberrant thrombus formation and deposition on blood vessel walls imderlies the pathogenesis of acute cardiovascular disease states which remain the principal cause of morbidity and mortality in the industrialized world [1,2,3]. Plasma proteins, proteases and specific cellular receptors that participate in hemostasis have emerged as important risk considerations in thrombosis and thromboembolic disorders. The clinical manifestations of the above disease states include acute coronary artery and cerebrovascular syndromes, peripheral arterial occlusion, deep vein thrombosis and pulmonary/renal embolism [3]. The most dilabilitating acute events precipitated by these disorders are myocardial infarction and stroke. In addition, the interplay between hemostatic factors and hypertension (4) or atherosclerosis (5) dramatically enhances the manifestation of these pathologic states. 

The efficacy of clopidogrel as an antiplatelet agent in atherothrombotic disorders was demonstrated in the CAPRIE trial. In this study of more than 19,000 patients with a history of either myocardial infarction (MI), stroke, or peripheral arterial disease (PAD), clopidogrel 75 mg/day was compared with aspirin 325 mg/day for its ability to decrease MI, stroke, or cardiovascular death. In the final analysis, clopidogrel was slightly (8% relative risk reduction [RRR]) more effective than aspirin (p =. 043) and had a similar incidence of adverse effects. It is not associated with the blood dyscrasias (neutropenia) common with its congener, ticlopidine, and is used widely in patients with atherosclerosis. 

Diabetes mellitus is now recognized as one of the most common and significant diseases facing Americans. It is estimated that I of 4 children bom today will become diabetic in their lifetime because of obesity and inactivity. Also, it has been noted that diabetes has a severe effect on blood vessels, particularly in the pathogenesis of atherosclerosis (blockage of arteries by lipids and plaque), which can lead to myocardial infarction or stroke. Diabetes mellitus is treated as equivalent to a prior cardiovascular event in its risk for future atherosclerotic disease. Diabetes is also associated with immunosuppression, renal insufficiency, blindness, neuropathy, and other metabolic disorders. 

In many respects stroke is a preventable disorder. Prevention is the target of a variety of programs to reduce risk factors for stroke. The aim of primary prevention is to reduce the risk of stroke in asymptomatic people. Hypertension, carotid artery stenosis, atrial fibrillation and certain other cardiac conditions, cigarette smoking, diabetes mellitus, dyslipidemia, sickle... 

Several hematologic disorders and hemostatic defects increase risk of ischemic stroke. Inherited thrombophilias (such as factor V Leiden protein S, protein C, or antithrombin III deficiency or the prothrombin G20210A mutation) rarely contribute to stroke in adults, but may play a larger role in pediatric stroke. Antiphospholipid antibody syndrome consists of venous and arterial occlusive disease in multiple organs, miscarriages, and livedo reticularis [7]. The association between antiphospholipid antibodies and stroke in the absence of antiphospholipid antibody syndrome is strongest for young adults. In the Antiphospholipid Antibodies in Stroke substudy of WARSS (WARSS/ APASS), antiphospholipid antibodies were detected in 40.7% of stroke patients, but they had no effect on the risk of stroke recurrence (see Table 2.5) [88]. Thrombotic thrombocytopenic purpura (TTP) has... 

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