Risk Factors Control and Early Recurrent Cerebral Infarction in Patients with Symptomatic Intracranial Atherosclerotic Disease

• Type of Material: Article
• Authors: Victor J Del Brutto, University of Miami Leonard M. Miller School of Medicine; David S Liebeskind, University of California, Los Angeles; Jose G Romano, University of Miami Leonard M. Miller School of Medicine; Iszet Campo-Bustillo, University of Miami Leonard M. Miller School of Medicine; George Cotsonis, Emory University; Azhar Nizam, Emory University; Shyam Prabhakaran, The University of Chicago
• Language: English
• Date: 2021-09-01
• Publisher: Elsevier Inc
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105914
• Title of Journal or Parent Work: Journal of Stroke and Cerebrovascular Diseases
• Volume: 30
• Issue: 9
• Start Page: 105914
• End Page: 105914
• Grant/Funding Information: NIH/NINDS (R01 NS084288).
• Keywords: Risk Factors; Exercise; Prospective Studies; Platelet Aggregation Inhibitors; Cerebral Infarction; Secondary Prevention; Sedentary Behavior; Recurrence; Intracranial Atherosclerotic Disease; Vascular risk factors; Female; Treatment Outcome; Blood Pressure; Aged; Middle Aged; Medication Compliance; Medication Adherence; Time Factors; Smoking Cessation; Hypolipidemic Agents; Risk Assessment; Intracranial Arteriosclerosis; Humans; Stroke Recurrence; Antihypertensive Agents; United States; Male; Risk Reduction Behavior
• Research Categories: Health Sciences, Public Health; Biology, Biostatistics

Abstract

Background: The risk of early recurrent cerebral infarction (RCI) is high in patients with symptomatic intracranial atherosclerotic disease (IAD). We sought to determine the relationship between risk factor control and early RCI risk among patients with symptomatic IAD. Methods: We analyzed participants with symptomatic IAD in the multi-center prospective observational MYRIAD study. Risk factor control was assessed at 6-8-week follow-up. Optimal risk factor control was defined by target systolic blood pressure, being non-smoker, target physical activity, and antiplatelet and antilipidemic therapy compliance. Age-adjusted associations were calculated between risk factor control and RCI determined by MRI-evident new infarcts in the territory of the stenotic vessel at 6-8 weeks from the index event. Results: Among 82 participants with clinical and brain MRI information available 6-8 weeks after the index event (mean age 63.5 ±12.5 years, 62.2% men), RCI occurred in 21 (25.6%) cases. At 6-8-week follow-up, 37.8% had target systolic blood pressure, 92.7% were non-smokers, 51.2% had target physical activity, and 98.8% and 86.6% were compliant with antiplatelet and antilipidemic therapy, respectively. Optimal risk factor control increased from 4.9% at baseline to 19.5% at 6-8-week follow-up (p=0.01). None of the participants with optimal risk factor control at follow-up had RCI (0% vs. 31.8%, p<0.01). Conclusions: Only one-fifth of MYRIAD participants had optimal risk factor control during early follow-up. Approximately half and two-thirds had physical inactivity and uncontrolled systolic blood pressure, respectively. These risk factors may represent important therapeutic targets to prevent early RCI in patients with symptomatic IAD.