American Stroke Association, Feb. 18-20, 2009
American Stroke Association International Stroke Conference
The American Stroke Association's International Stroke Conference took place Feb. 18 to 20 in San Diego and attracted 4,319 attendees from around the world, including 3,563 professionals. Highlights included advances in basic research, new health policy initiatives, and several large studies with findings that could change clinical practice.
"The breadth of the conference was pretty astounding," said Larry Goldstein, M.D., of Duke University in Durham, N.C., national spokesperson for the American Stroke Association and past chair of the American Heart Association/American Stroke Association Stroke Council. "Some of the big studies were potentially interesting and others were disappointing."
One of the most widely discussed studies was the landmark Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study, in which 17,802 patients with low cholesterol but high levels of C-reactive protein were randomly assigned to 20 mg a day of rosuvastatin or placebo and followed-up for up to five years. During the study, the rosuvastatin group experienced significantly fewer strokes (33 versus 64), suggesting that the treatment is associated with a 48 percent reduction in stroke risk.
"It's a very well done study," Goldstein said. "But how it's going to affect practice is something we're going to have to think about. The numbers needed to treat in stroke are high, and there have been some back-of-the-envelope calculations about what it would cost for wide-scale screening and treatment."
In the JUPITER study, which was sponsored by AstraZeneca, Robert Glynn, Ph.D., of Harvard School of Public Health and Brigham and Women's Hospital in Boston, and colleagues observed that rosuvastatin helped reduce stroke risk among all subgroups and was well tolerated during the study period.
"Each year in the U.S. about 795,000 people experience a new or recurrent stroke and about 610,000 of these are first attacks," Alex Gold, M.D., executive director of clinical development at CRESTOR U.S., said in a statement. "This analysis of the JUPITER data evaluated rosuvastatin 20 mg across a number of subgroups with notable benefits in higher risk patients, including those older than 70 years, cigarette smokers, hypertensives, those with an elevated Framingham risk score, and those with a high-sensitivity C-reactive protein level at or above 5 mg/L at baseline."
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Another large-scale study, which was presented by Justin Zivin, M.D., of the University of California, and funded by the laser's manufacturer -- PhotoThera, Inc. -- showed that low-radiation infrared laser therapy failed to significantly reduce stroke disability. "There was some encouraging news from an earlier study," Goldstein said. "However, this one apparently didn't pan out, at least in terms of the primary preplanned outcome."
"Although our primary endpoint of improvement for overall stroke disability missed reaching statistical significance, we saw no ill effects from the laser treatment," Zivin said in a statement. "And, in fact, there was a strong signal that this treatment actually offered some improvement for patients with moderate to moderately severe strokes, even in the presence of prior risk factors such as previous stroke, heart disease and diabetes. For a trial that failed, this one was reasonably encouraging."
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Several studies addressed the issue of stroke in women. "Stroke is a major killer of women, and about 60 percent of stroke deaths are in women," Goldstein said. "But one the studies -- of which I was a co-author -- found that elderly women who have had a transient ischemic attack have a lower one-year risk than their male counterparts of experiencing a subsequent stroke, coronary artery disease hospitalization, or death. It's unclear why this is the case. But it's clear that women did better, which is a good thing."
During that study, Judith Lichtman, Ph.D., of the Yale School of Medicine in New Haven, Conn., and colleagues followed elderly patients who were hospitalized for a transient ischemic attack. "Additional research is needed to identify factors that may explain these sex-associated differences in outcomes," Lichtman and colleagues concluded.
Another study by Lichtman and colleagues showed that caution may be warranted when performing carotid endarterectomy in very elderly patients, Goldstein said. "We found that the rates of death afterward were quite high compared to what we would have hoped for based on randomized controlled trials that excluded patients in their 80s and 90s."
In that study, the researchers found a significant increase in the number of carotid endarterectomies performed in octogenarians and nonagenarians. In both groups, they found that mortality rates steadily increased over time. "The effect of carotid endarterectomy on stroke-free survival and health status in the very elderly is unclear with more data needed as increasing numbers of patients in this age range are having the operation," the authors concluded.
ASA: Early Menopause Linked to Ischemic Stroke
FRIDAY, Feb. 20 (HealthDay News) -- Early menopause may be a risk factor for ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Combo Clot-Busting Therapy Beneficial in Stroke
FRIDAY, Feb. 20 (HealthDay News) -- In acute stroke patients, sonothrombolysis with microspheres and tPA may be associated with higher rates of early recanalization and clinical recovery than treatment with tPA alone, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Tea or Coffee May Help Prevent Ischemic Stroke
FRIDAY, Feb. 20 (HealthDay News) -- Increased consumption of tea or coffee is associated with reduced risk of ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Most U.S. Hospitals Don't Offer tPA Therapy
FRIDAY, Feb. 20 (HealthDay News) -- Nearly two-thirds of the nation's hospitals do not report treating acute ischemic stroke patients with recombinant tissue-type plasminogen activator (tPA), leaving many Americans without access to the brain-saving therapy, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Gender Differences Seen in Stroke Care and Awareness
THURSDAY, Feb. 19 (HealthDay News) -- Women may be less likely than men to receive tissue plasminogen activator for stroke, but may be increasingly likely to be aware of acute stroke symptoms and quickly present at emergency departments, according to research presented during a "Women and Stroke" press conference at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
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ASA: Good Adherence to Therapy May Benefit Stroke Patients
THURSDAY, Feb. 19 (HealthDay News) -- In stroke patients, good adherence to recommended therapy could be associated with improved clinical outcomes. In patients with known cardiovascular disease, a homocysteine-lowering vitamin regimen also may be associated with better outcomes, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Younger Stroke Patients May Be Misdiagnosed
THURSDAY, Feb. 19 (HealthDay News) -- When younger patients present to the emergency department with stroke-like symptoms, they are often misdiagnosed and sent home. In addition, pharmacists often give inappropriate advice to patients who call to complain about stroke-like symptoms, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: Silent Strokes Common in Younger Patients
THURSDAY, Feb. 19 (HealthDay News) -- In middle age, people are significantly more likely to have a silent cerebral infarction than a clinical stroke, according to research presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
ASA: 'Golden Hour' Stroke Patients More Likely to Get tPA
WEDNESDAY, Feb. 18 (HealthDay News) -- At hospitals participating in the Get With The Guidelines-Stroke program, patients who arrive within one hour of symptom onset (the "golden hour") are twice as likely to receive tissue plasminogen activator (tPA) as those who arrive with one to three hours. But hospital overcrowding can lengthen the time it takes stroke patients to receive needed care, according to two studies presented at the American Stroke Association's International Stroke Conference held Feb. 18 to 20 in San Diego.
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