Cardiovascular disease
Sally Robinson in Priorities for Health Promotion and Public Health, 2021
Cerebrovascular disease refers to several conditions that affect the blood vessels in the brain. A cerebrovascular accident (CVA), or a stroke, means that the blood supply to part of the brain has been interrupted. Most strokes are ischaemic, meaning they are caused because of a blood clot, often due to atherosclerosis. Some are the result of a haemorrhage, meaning a blood vessel burst. The symptoms of a stroke include the face may drop on one side, the individual may be unable to smilean inability to lift both arms and keep them thereslurred or garbled speech(NHS, 2019a)
Introduction
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees in Stroke in Practice, 2017
In the medical literature, the term stroke is reserved for neurological deficits lasting more than 24 hours, and indeed the WHO definition sets this arbitrary time window as a prerequisite for distinguishing stroke from a transient ischaemic attack (TIA). The latter typically lasts less than 20 minutes but by definition no longer than 24 hours, with full recovery. Stroke and TIA should best be thought of as a continuum, as the same risk factors underpin both disease processes and the latter often heralds the former. The temporal threshold that separates stroke from TIA has been criticised and alternate definitions have been proposed; these are discussed in Chapter 7. Cerebrovascular disease is a broader term embracing stroke, vascular dementia, asymptomatic disorders of cerebral vessels, and TIA. It denotes a wide spectrum of disease caused by disturbances of cerebral blood flow or blood vessel pathology.3
Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Strokes are commonly seen in the elderly population, and are often terminal events. The risk factors for cerebrovascular disease are the same as those for cardiovascular disease, such as hypertension, diabetes, hypercholesterolaemia and smoking. Patients with atrial fibrillation are also at an increased risk of stroke due to the formation of thrombus in the left atrium and subsequent embolisation to the cerebral arteries. The arterial network in the brain is called the Circle of Willis. The anterior communicating artery links the two anterior cerebral arteries, and the posterior communicating arteries link the internal carotid arteries to the posterior cerebral arteries. This allows redistribution of blood flow within the brain if it has been compromised.
The prevalence, low-density lipoprotein cholesterol levels, and treatment of patients at very high risk of cardiovascular events in the United Kingdom: a cross-sectional study
Published in Current Medical Research and Opinion, 2018
Mark D. Danese, Eduard Sidelnikov, Lucie Kutikova
Patients with documented CVD were further divided into three sub-groups, based on the type of event they had experienced: coronary artery disease (CAD), cerebrovascular disease, or PAD. The CAD sub-group included patients with MI, unstable or stable angina, and revascularization (including percutaneous coronary intervention and coronary artery bypass grafting). The cerebrovascular disease sub-group included patients with ischemic stroke, transient ischemic attack (TIA) and carotid stenosis. This paper focuses on ischemic events, as the risk of these events are related to LDL-C levels; hemorrhagic stroke isn’t and so was not included. The PAD sub-group included patients with PAD and also those with abdominal aortic aneurysm. The CVD sub-groups were made mutually exclusive using the following hierarchy: (1) CAD, (2) cerebrovascular disease, (3) PAD. Therefore, patients with CAD were classified as “CAD”, regardless of whether they also had any other type of CV event, patients with cerebrovascular disease were classified as “cerebrovascular disease”, even if they also had PAD (but these could not have CAD), while patients classified as “PAD” had experienced no cerebrovascular disease or CAD. Multiple CV events refers to two or more occurrences of MI, unstable angina, revascularization, ischemic stroke, or TIA. Polyvascular disease refers to atherosclerosis in at least two vascular beds (coronary, cerebral, or peripheral vascular bed).
Comorbidity patterns among people living with HIV: a hierarchical clustering approach through integrated electronic health records data in South Carolina
Published in AIDS Care, 2021
Xueying Yang, Jiajia Zhang, Shujie Chen, Sharon Weissman, Bankole Olatosi, Xiaoming Li
The hierarchical cluster analysis identified four comorbidity clusters from the 24 diagnosis groups. As shown in Figure 2, the four comorbidity clusters were: (1) “substance use and mental disorders” (6 diagnosis groups: alcohol use, tobacco use, anxiety, depression, psychiatric disorders, illicit drug use); (2) “metabolic disorders” (10 diagnosis groups: hypothyroidism, anemia, diabetes, dyslipidemia, cardiac disorders, hypertension, ulcer disease, chronic obstructive pulmonary disease [COPD], osteoporosis/osteoarthritis, chronic kidney disease); (3) “liver disease and cancer” (4 diagnosis groups: hepatitis B, chronic liver disease, hepatitis C, non-AIDS defining cancers); and (4) “cerebrovascular disease” (4 diagnosis groups: stroke, cerebral infarction, peripheral vascular disease, dementia). The concurrence (in %) of comorbidity clusters among all the PLWH were shown in Figure 3, with 11.50% of the patients being diagnosed only with substance use and mental disorders (cluster 1), 12.94% only with metabolic disorders (cluster 2), 0.52% only with liver diseases and cancer (cluster 3) and 0.09% only with cerebrovascular disease (cluster 4). In the meantime, the 2 most frequent concurrent dyads were: clusters 1 and 2 (22.56%) and clusters 2 and 3 (1.30%). The 2 most frequent concurrent triads were clusters 1, 2, and 3 (6.22%) and clusters 1, 2, and 4 (2.41%). The proportion of patients who were diagnosed with all four clusters was low (1.32%).
Contemporary Prevalence and risk factors of carotid artery stenosis in asymptomatic low-income Chinese individuals: a population-based study
Published in Postgraduate Medicine, 2020
Kai Zhang, Qiuxing Lin, Tianyu Zhang, Dandan Guo, Li Cao
This population-based study explored the contemporary prevalence and risk factors for CAS in an asymptomatic low-income population aged at least 45 years. The overall prevalence of CAS in this population was 6.7% (8.8% in men and 5.0% in women); there were significant associations between the presence of CAS and older age, current drinking, SBP, and LDL-C. Each 1-mmHg increase in SBP increased the risk of CAS by 1.1%, each 1-mmol/L increase in LDL-C increased the risk of CAS by 19.2%, and each 1-mmol/L increase in FBG increased the risk of CAS by 6.7%. There was no significant link between CAS and smoking status. These findings suggest that the prevalence of CAS is high in a low-income Chinese population. In addition, to prevent cerebrovascular disease and reduce the severe disease-associated burden, these findings suggest a strong need to control these risk factors for CAS.