BACKGROUND: The clinical significance of aspirin resistance (AR) in patients with symptomatic cerebrovascular disease is not well known. The aim of this single-center, prospective study was to examine the prevalence, risk factors and prognostic significance of AR in patients with different clinical manifestations of cerebral small vessel disease (CSVD) over 24-month follow-up. METHODS: We studied 104 patients with MRI confirmed CSVD, including those with recent lacunar stroke (LS, n=49), vascular parkinsonism (VaP, n=16) and dementia (VaD, n=39). Platelet aggregation was evaluated with electrode platelet aggregometry (Multiplate analyzer); AR was defined as a value of ≥300 AUC*min. All patients had 24-h ABPM performed at baseline. Radiological progression was recognized based on repeated MRI examinations. RESULTS: The prevalence of AR was 26%, and it did not differ between LS, VaD, and VaP (22.4%, 28.2%, and 31.3%, respectively; p=0.7). The patients with AR had higher triglyceride levels (TG; 144.2±100 vs 109.7±48 mg/dl; p=0.09) and mean arterial blood pressure (MAP; 103.5±15.2 vs 91.7±10.5 mmHg; p<0.01) than did responders to aspirin (RTA). TG (OR 1.02; 95%CI 1-1.11; p=0.04) and MAP (OR 1.03; 95%CI 1.0-1.09; p=0.04) were independent of age, sex, statin and antihypertensive treatment risk factors for AR. The patients with AR more frequently experienced ischemic strokes than did those with RTA (OR 3.1; 98%CI 1.08-9.3; p=0.03) and had more radiological progression (OR 2.2; 95%CI 0.9-5.7; p=0.08). AR was independent of age, sex, baseline Fazekas score predictor of lacunar stroke (OR 3.79; 95%CI 1.19-12; p=0.02) and radiological progression (OR 2.9; 95%CI 1.04-8.3; p=0.04). CONCLUSIONS: The prevalence of AR was high and similar among the patients with LS, VaD, and VaP due to CSVD. Higher 24-h MAP and TG were independently related to the risk of AR. AR was associated with risk of radiological progression and lacunar strokes over 24 months of observation.
BACKGROUND: The clinical significance of aspirin resistance (AR) in patients with symptomatic cerebrovascular disease is not well known. The aim of this single-center, prospective study was to examine the prevalence, risk factors and prognostic significance of AR in patients with different clinical manifestations of cerebral small vessel disease (CSVD) over 24-month follow-up. METHODS: We studied 104 patients with MRI confirmed CSVD, including those with recent lacunar stroke (LS, n=49), vascular parkinsonism (VaP, n=16) and dementia (VaD, n=39). Platelet aggregation was evaluated with electrode platelet aggregometry (Multiplate analyzer); AR was defined as a value of ≥300 AUC*min. All patients had 24-h ABPM performed at baseline. Radiological progression was recognized based on repeated MRI examinations. RESULTS: The prevalence of AR was 26%, and it did not differ between LS, VaD, and VaP (22.4%, 28.2%, and 31.3%, respectively; p=0.7). The patients with AR had higher triglyceride levels (TG; 144.2±100 vs 109.7±48 mg/dl; p=0.09) and mean arterial blood pressure (MAP; 103.5±15.2 vs 91.7±10.5 mmHg; p<0.01) than did responders to aspirin (RTA). TG (OR 1.02; 95%CI 1-1.11; p=0.04) and MAP (OR 1.03; 95%CI 1.0-1.09; p=0.04) were independent of age, sex, statin and antihypertensive treatment risk factors for AR. The patients with AR more frequently experienced ischemic strokes than did those with RTA (OR 3.1; 98%CI 1.08-9.3; p=0.03) and had more radiological progression (OR 2.2; 95%CI 0.9-5.7; p=0.08). AR was independent of age, sex, baseline Fazekas score predictor of lacunar stroke (OR 3.79; 95%CI 1.19-12; p=0.02) and radiological progression (OR 2.9; 95%CI 1.04-8.3; p=0.04). CONCLUSIONS: The prevalence of AR was high and similar among the patients with LS, VaD, and VaP due to CSVD. Higher 24-h MAP and TG were independently related to the risk of AR. AR was associated with risk of radiological progression and lacunar strokes over 24 months of observation.
Authors: Peter Alexander; Shakthi Visagan; Sara Jawhar; Amogh Kare; Noor Issa; Reem Issa; Abbas Jawhar; Sneha Thomas; Vasavi Gorantla Journal: J Aging Res Date: 2022-09-19