Logan T Cowan1, Alvaro Alonso2, James S Pankow2, Aaron R Folsom2, Wayne D Rosamond2, Rebecca F Gottesman2, Kamakshi Lakshminarayan2. 1. From the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (L.T.C., A.A., J.S.P., A.R.F., K.L.); Department of Epidemiology, University of North Carolina, Chapel Hill (W.D.R.); and Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.). cowan046@umn.edu. 2. From the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (L.T.C., A.A., J.S.P., A.R.F., K.L.); Department of Epidemiology, University of North Carolina, Chapel Hill (W.D.R.); and Department of Neurology, Johns Hopkins University, Baltimore, MD (R.F.G.).
Abstract
BACKGROUND AND PURPOSE: Acute triggers for ischemic stroke, which may include infection, are understudied, as is whether background cardiovascular disease (CVD) risk modifies such triggering. We hypothesized that infection increases acute stroke risk, especially among those with low CVD risk. METHODS: Hospitalized strokes and infections were identified in the Atherosclerosis Risk in Communities (ARIC) cohort. A case-crossover design and conditional logistic regression were used to compare hospitalized infections among patients with stroke (14, 30, 42, and 90 days before stroke) with corresponding control periods 1 year and 2 years before stroke. Background CVD risk was assessed at both visit 1 and the visit most proximal to stroke, with risk dichotomized at the median. RESULTS: A total of 1008 adjudicated incident ischemic strokes were included. Compared with control periods, hospitalized infection was more common within 2 weeks before stroke (14-day odds ratio [OR], 7.7; 95% CI, 2.1-27.3); the strength of association declined with increasing time in the exposure window before stroke (30-day OR, 5.7 [95% CI, 2.3-14.3]; 42-day OR, 4.5 [95% CI, 2.0-10.2]; and 90-day OR, 3.6 [95% CI, 2.1-6.5]). Stroke risk was higher among those with low compared with high CVD risk, with this interaction reaching statistical significance for some exposure periods. CONCLUSIONS: These results support the hypothesis that hospitalized infection is a trigger of ischemic stroke and may explain some cryptogenic strokes. Infection control efforts may prevent strokes. CVD preventive therapies may prevent strokes if used in the peri-infection period, but clinical trials are needed.
BACKGROUND AND PURPOSE: Acute triggers for ischemic stroke, which may include infection, are understudied, as is whether background cardiovascular disease (CVD) risk modifies such triggering. We hypothesized that infection increases acute stroke risk, especially among those with low CVD risk. METHODS: Hospitalized strokes and infections were identified in the Atherosclerosis Risk in Communities (ARIC) cohort. A case-crossover design and conditional logistic regression were used to compare hospitalized infections among patients with stroke (14, 30, 42, and 90 days before stroke) with corresponding control periods 1 year and 2 years before stroke. Background CVD risk was assessed at both visit 1 and the visit most proximal to stroke, with risk dichotomized at the median. RESULTS: A total of 1008 adjudicated incident ischemic strokes were included. Compared with control periods, hospitalized infection was more common within 2 weeks before stroke (14-day odds ratio [OR], 7.7; 95% CI, 2.1-27.3); the strength of association declined with increasing time in the exposure window before stroke (30-day OR, 5.7 [95% CI, 2.3-14.3]; 42-day OR, 4.5 [95% CI, 2.0-10.2]; and 90-day OR, 3.6 [95% CI, 2.1-6.5]). Stroke risk was higher among those with low compared with high CVD risk, with this interaction reaching statistical significance for some exposure periods. CONCLUSIONS: These results support the hypothesis that hospitalized infection is a trigger of ischemic stroke and may explain some cryptogenic strokes. Infection control efforts may prevent strokes. CVD preventive therapies may prevent strokes if used in the peri-infection period, but clinical trials are needed.
Authors: J B Muhlestein; J L Anderson; J F Carlquist; K Salunkhe; B D Horne; R R Pearson; T J Bunch; A Allen; S Trehan; C Nielson Journal: Circulation Date: 2000-10-10 Impact factor: 29.690
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson; Harmon S Jordan; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: Jacob A Udell; Rami Zawi; Deepak L Bhatt; Maryam Keshtkar-Jahromi; Fiona Gaughran; Arintaya Phrommintikul; Andrzej Ciszewski; Hossein Vakili; Elaine B Hoffman; Michael E Farkouh; Christopher P Cannon Journal: JAMA Date: 2013-10-23 Impact factor: 56.272
Authors: José Fernando Vilela-Martin; Renan Oliveira Vaz-de-Melo; Cristina Hiromi Kuniyoshi; André Neder Ramires Abdo; Juan Carlos Yugar-Toledo Journal: Hypertens Res Date: 2010-12-16 Impact factor: 3.872
Authors: Mitchell S V Elkind; Cara L Carty; Ellen S O'Meara; Thomas Lumley; David Lefkowitz; Richard A Kronmal; W T Longstreth Journal: Stroke Date: 2011-05-05 Impact factor: 7.914
Authors: Mitchell S V Elkind; Amelia K Boehme; Craig J Smith; Andreas Meisel; Marion S Buckwalter Journal: Stroke Date: 2020-09-08 Impact factor: 7.914
Authors: Yohane G Gadama; Gloria Mwangalika; Louis B Kinley; Beth Jackson; Henry C Mwandumba; Jane Mallewa; Tom Solomon; Rob Simister; Laura A Benjamin; Maria I Vargas; Joseph Kamtchum-Tatuene; Tamara Phiri Journal: Malawi Med J Date: 2017-06 Impact factor: 0.875
Authors: Amelia K Boehme; Jorge Luna; Erin R Kulick; Hooman Kamel; Mitchell S V Elkind Journal: Ann Clin Transl Neurol Date: 2018-03-14 Impact factor: 4.511
Authors: Joseph Kamtchum-Tatuene; Zaid Al-Bayati; Henry Charles Mwandumba; Tom Solomon; Stephen E Christmas; Laura A Benjamin Journal: PLoS One Date: 2018-11-27 Impact factor: 3.240