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2016 ; 47
(6
): 1612-7
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Hospitalized Infection as a Trigger for Acute Ischemic Stroke: The
Atherosclerosis Risk in Communities Study
#MMPMID27165961
Cowan LT
; Alonso A
; Pankow JS
; Folsom AR
; Rosamond WD
; Gottesman RF
; Lakshminarayan K
Stroke
2016[Jun]; 47
(6
): 1612-7
PMID27165961
show ga
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.