| Abstract |
Background Ιschemic stroke remains one of the main causes of morbidity and mortality
worldwide. It is ranked as the 4th cause of death in the United States and 3rd in Europe. Moreover,
it is considered as the leading cause of severe, long-term disability. Primary prevention represents
the best approach for the reduction of ischemic stroke incidence and burden. To date, there are
numerous reports in the literature regarding the causative effect of the risk factors on the
incidence of the ischemic stroke. However, their correlation with initial stroke severity and the
functional outcome are not well established as of yet.
Aim This study aims to correlate the stroke risk factors, their control and their treatment with the
severity of the first ischemic stroke and its functional outcome.
Methods The participants included in this prospective study were patients with a first-diagnosed
ischemic stroke, either thrombolysed or not. A medical history focused on their risk factors (age,
sex, exercice, dyslipidemia, hypertension, obesity, diabetes mellitus, atrial fibrillation) and
chronic medical treatment was recorded. We compared all the aforementioned risk factors with
the severity and the functional outcome. The stroke severity was evaluated with NIHSS scale that
was conducted on the admission and on discharge. The functional outcome was assessed with
mRS scale pre- stroke, on discharge and 3 months later.
Results Data were obtained from 119 patients, 70 men and 49 women. The initial severity was
greater in males compared to their female counterparts. Furthermore, there was a positive
correlation of age with the stroke severity and the functional outcome. Patients with controlled
hypertension had a lesser stroke severity on admission (NIHSS: 5,24 vs non controlled
hypertension: 10,38) and on discharge (NIHSS: 1,65 vs 7,77), a better early functional outcome
(mRS: 1,88 vs 2,97) and long-term functional outcome (mRS: 1,80 vs 2,95). The use of
antihypertensive drugs that increase angiotensin II formation was associated with less severe
ischemic stroke (ΝΙΗSS admission: 8,53 and discharge: 4,76) compared to antihypertensive
drugs that suppress angiotensin II formation (ΝΙΗSS admission: 17 and discharge: 8,86) and
better early functional outcome (mRS Ang II: 2,38 vs non Ang II: 3,6). No significant differences noted in diabetic stroke patients who were treated with thrombolysis compared to the nonthrombolysed
ones, neither in the stroke severity nor in the functional recovery. Diabetic stroke
patients showed no improvement in clinical outcome (NIHSS admission – discharge: 0,86) after
thrombolytic treatment, compared to thrombolysed non-diabetic patients (6,96). Atrial fibrillation
was associated with increased neurological severity (ΝΙΗSS admission: 13,26 vs non AF: 6,88,
ΝΙΗSS discharge: 7,08 vs 4,33) and poor early functional outcome (mRS: 3,53 vs 2,14). Patients
treated with anticoagulant therapy, especially NOACs, developed mild neurological symptoms
and had better functional recovery. Prior treatment with a three-drug combination, (antiplatelets,
antihypertensives and statins) influenced both stroke severity and functional outcome.
Conclusion Age and atrial fibrillation were the only risk factors that were associated with
increased neurological severity and greater functional disability. Adequate hypertension control
was correlated with reduced stroke severity and better functional outcome. Additionally, the
pharmacological agents that increase Ang II formation, anticoagulation therapy and the threedrug
combination (antiplatelet, antihypertensive and statin) were associated with reduced
neurological severity and improved therapy outcomes. Thrombolysis didn’t change the course of
the stroke in diabetic patients. A study including larger numbers of patients is needed in order to
elucidate the effect of other stroke risk factors on initial stroke severity.
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Συσχέτιση παραγόντων κινδύνου ΑΕΕ με τη βαρύτητα του πρώτου ισχαιμικού ΑΕΕ.
