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Recent Advances in Leukoaraiosis: White Matter Structural Integrity and Functional Outcomes after Acute Ischemic Stroke
AbstractLeukoaraiosis, a radiographic marker of cerebral small vessel disease detected on T2-weighted brain magnetic resonance imaging (MRI) as white matter hyperintensity (WMH), is a key contributor to the risk and severity of acute cerebral ischemia. Prior investigations have emphasized the pathophysiology of WMH development and progression; however, more recently, an association between WMH burden and functional outcomes after stroke has emerged. There is growing evidence that WMH represents macroscopic injury to the white matter and that the extent of WMH burden on MRI influences functional recovery in multiple domains...
Source: Current Cardiology Reports - October 30, 2016 Category: Cardiology Source Type: research

Genetic Risk Factors for Ischemic and Hemorrhagic Stroke
AbstractUnderstanding the genetic risk factors for stroke is an essential step to decipher the underlying mechanisms, facilitate the identification of novel therapeutic targets, and optimize the design of prevention strategies. A very small proportion of strokes are attributable to monogenic conditions, the vast majority being multifactorial, with multiple genetic and environmental risk factors of small effect size. Genome-wide association studies and large international consortia have been instrumental in finding genetic risk factors for stroke. While initial studies identified risk loci for specific stroke subtypes, more...
Source: Current Cardiology Reports - October 30, 2016 Category: Cardiology Source Type: research

Cardiovascular Complications of HIV in Endemic Countries
AbstractEffective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD ris...
Source: Current Cardiology Reports - October 11, 2016 Category: Cardiology Source Type: research

Progressing Insights into the Role of Dietary Fats in the Prevention of Cardiovascular Disease
AbstractDietary fats have important effects on the risk of cardiovascular disease (CVD). Abundant evidence shows that partial replacement of saturated fatty acids (SAFA) with unsaturated fatty acids improves the blood lipid and lipoprotein profile and reduces the risk of coronary heart disease (CHD). Low-fat diets high in refined carbohydrates and sugar are not effective. Very long-chain polyunsaturated n-3 or omega-3 fatty acids (n-3 VLCPUFA) present in fish have multiple beneficial metabolic effects, and regular intake of fatty fish is associated with lower risks of fatal CHD and stroke. Food-based guidelines on dietary ...
Source: Current Cardiology Reports - September 19, 2016 Category: Cardiology Source Type: research

A Bridge to Nowhere? Benefits and Risks for Periprocedural Anticoagulation in Atrial Fibrillation
AbstractIn patients with atrial fibrillation (AF), oral anticoagulation is used to prevent stroke and systemic embolism. In a common clinical scenario, AF patients frequently undergo invasive procedures requiring temporary interruption of oral anticoagulation, thereby potentially exposing such patients to increased risk of thromboembolism. Bridging anticoagulation has been used clinically to mitigate this perceived thromboembolic risk, though this practice may also increase risk of periprocedural bleeding. High-quality data has not previously existed to inform decision-making in this clinical situation of bridging anticoag...
Source: Current Cardiology Reports - August 28, 2016 Category: Cardiology Source Type: research

BP Targets in Hypertension: What Should We Do Now That SPRINT Is Out?
AbstractSystolic blood pressure (SBP) is an important predictor of cardiovascular disease (CVD) outcomes. Lowering SBP has been shown to reduce CVD morbidity and mortality, but the optimal SBP target continues to be a topic of intense debate. The Systolic Blood Pressure Intervention Trial (SPRINT) reported a significantly lower risk for CVD outcomes and all-cause mortality by targeting SBP<120  mmHg compared with<140  mmHg in a population of hypertensive persons at high CV risk. In this review, we discuss the strengths, limitations, and generalizability of SPRINT findings to other hypertensive populations that were...
Source: Current Cardiology Reports - August 26, 2016 Category: Cardiology Source Type: research

Management of Symptomatic Intracranial Stenosis
Abstract Intracranial atherosclerotic disease is a common cause of stroke worldwide, causing approximately 10 % of strokes in the USA and up to 50 % in Asian populations. Recurrent stroke risks are particularly high in those with a stenosis of 70 % or more and a recent transient ischemic attack or stroke. Warfarin has been associated with higher major hemorrhage rates and no reduction of recurrent stroke compared to aspirin in patients with symptomatic intracranial stenosis. After early trials showed the feasibility of stenting, two randomized trials compared stenting plus medical management to medical managem...
Source: Current Cardiology Reports - July 20, 2016 Category: Cardiology Source Type: research

Genomics of Atrial Fibrillation
Abstract Atrial fibrillation (AF) is a common clinical arrhythmia that appears to be highly heritable, despite representing a complex interplay of several disease processes that generally do not manifest until later in life. In this manuscript, we will review the genetic basis of this complex trait established through studies of familial AF, linkage and candidate gene studies of common AF, genome wide association studies (GWAS) of common AF, and transcriptomic studies of AF. Since AF is associated with a five-fold increase in the risk of stroke, we also review the intersection of common genetic factors associated...
Source: Current Cardiology Reports - April 29, 2016 Category: Cardiology Source Type: research

Molecular Cardiovascular Magnetic Resonance: Current Status and Future Prospects
Abstract In the Western world and developing countries, the number one causes of mortality and morbidity result from cardiovascular diseases. Cardiovascular diseases represent a wide range of pathologies, including myocardial infarction, peripheral vascular disease, and cerebrovascular disease, which are all linked by a common cause - atherosclerosis. Currently, the diagnosis of atherosclerosis is in most cases established at the end stage of the disease, when patients are administered to the emergency room due to a myocardial infarction or stroke. Even though cardiovascular diseases have an enormous impact on ...
Source: Current Cardiology Reports - April 1, 2016 Category: Cardiology Source Type: research

The Role of Manual Aspiration Thrombectomy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI
Abstract In STEMI, primary PCI restores macrovascular coronary blood flow effectively but microvascular perfusion remains a challenge. Thrombus has the potential to embolize to the microvasculature limiting effective coronary blood flow. Thrombus burden is associated with a higher mortality and manual aspiration thrombectomy has the potential to reduce thrombus burden. The first large trial of routine aspiration thrombectomy (TAPAS, N = 1071) showed an improvement in myocardial blush and an unexpected reduction in mortality. Reinforcing the enthusiasm for this finding meta-analysis of small trials also showed...
Source: Current Cardiology Reports - February 18, 2016 Category: Cardiology Source Type: research

Protection from Cerebral Embolic Events During Transcatheter Aortic Valve Replacement
Abstract Transcatheter aortic valve replacement (TAVR) has been a major advancement in the treatment of high-risk patients with severe aortic stenosis. One of the primary concerns in applying this procedure to a broader patient population is the risk of embolic stroke. Cerebral emboli have been shown to originate from atheromatous plaques within the aorta and from the degenerate stenotic aortic valve itself. Thus, there has been significant interest in embolic protection devices designed to either filter or deflect potential cerebral emboli during TAVR. Here, we review the rationale and current data for embolic p...
Source: Current Cardiology Reports - January 14, 2016 Category: Cardiology Source Type: research

Atrial Fibrillation Monitoring in Cryptogenic Stroke: the Gaps Between Evidence and Practice
Abstract Identifying occult paroxysmal atrial fibrillation as the etiology of cryptogenic stroke has been a top research priority in the past decade. This is because prompt initiation of anticoagulation has significantly decreased subsequent stroke risk. Available evidence suggests that prolonged cardiac monitoring after stroke increases the likelihood of detecting atrial fibrillation. However, further research is required to fill in the gaps in regard to the optimal period of monitoring, candidates for monitoring, etc. Here, we review the current evidence supporting the use of prolonged monitoring for cryptogeni...
Source: Current Cardiology Reports - October 20, 2015 Category: Cardiology Source Type: research

The Year Embolectomy Won: a Review of Five Trials Assessing the Efficacy of Mechanical Intervention in Acute Stroke
This article will compare and contrast this most recent evidence.
Source: Current Cardiology Reports - September 16, 2015 Category: Cardiology Source Type: research

Dual Antiplatelet Therapy with Clopidogrel and Aspirin for Secondary Stroke Prevention
This article aims at providing a comprehensive review of the evidence on the use of aspirin plus clopidogrel for secondary stroke prevention, with special focus on important studies that may impact clinical practice of treating patients with stroke or transient ischemic attack.
Source: Current Cardiology Reports - August 20, 2015 Category: Cardiology Source Type: research

Changing Contraindications for t-PA in Acute Stroke: Review of 20 Years Since NINDS
Abstract When intravenous (IV) tissue-type plasminogen activator (t-PA) was originally approved by the Food and Drug Administration (FDA) for acute ischemic stroke (AIS) in 1996, there was a lengthy list of contraindications. In the 19 years since the approval of t-PA for AIS, it has been used off label and in patients with those contraindications. In February 2015, the list of contraindications for IV t-PA in AIS was revised and several of the previous contraindications were removed. As only 4 % of patients with ischemic stroke receive treatment with IV t-PA, these changes increase the number of patients eligi...
Source: Current Cardiology Reports - August 16, 2015 Category: Cardiology Source Type: research

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