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Increased pulse wave velocity in patients with acute lacunar infarction doubled the risk of future ischemic stroke

Abstract

The aim of this study was to determine whether pulse wave velocity (PWV), a marker of vascular endothelial impairment and arteriosclerosis, predicts future ischemic stroke in patients who developed acute lacunar infarction. Patients with a first-ever ischemic stroke due to acute lacunar infarction were enrolled in this study. An oscillometric device (Form PWV/ABI; Omron Colin, Tokyo, Japan) was used to measure brachial–ankle PWV 1 week after stroke onset. Patients were followed for at least 5 years. The main end point of the study was recurrent ischemic stroke. Event-free survival was analyzed using Kaplan–Meier plots and log-rank tests. The risk of recurrent ischemic stroke was estimated using the Cox proportional-hazards model. Of the 156 patients (61% male, mean age: 69.2±11.3 years) assessed in this study, 29 developed recurrent ischemic stroke. The median brachial–ankle PWV value was 20.4 m s−1. Patients with high PWV values had a greater risk of recurrent ischemic stroke than patients with low PWV values (28% vs. 15%, P=0.08). Kaplan–Meier curve analysis showed that patients with high PWV values had a less favorable (that is, free of recurrent ischemic stroke) survival time (P=0.015). A multivariate Cox proportional-hazards model identified high PWV as an independent predictor of recurrent ischemic stroke after adjusting for age, sex and blood pressure (hazard ratio 2.35, 95% confidence interval, 1.02–5.70, P=0.044). In patients with acute lacunar infarction, a high PWV predicts a twofold greater risk of future ischemic stroke, independent of patient age, sex and blood pressure levels.

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Acknowledgements

We thank Naoko Akazawa, Tomoko Yunoki, Hiroko Ohta and Mari Okamoto for their secretarial assistance. This study was partially funded by the KAWASAKI Foundation for Medical Science & Medical Welfare, Research Funding of Longevity Sciences (25-6, 28-15) from the National Center for Geriatrics and Gerontology and Grants-in-Aid for Scientific Research (no 26870765) from the Japan Society for the Promotion of Science. Dr NS was the recipient of the research funding from the KAWASAKI Foundation for Medical Science & Medical Welfare, Research Funding for Comprehensive Research on Aging and Health from the Japan Agency for Medical Research and Development, Research Funding of Longevity Sciences (25-6, 28-15) from the National Center for Geriatrics and Gerontology, Grants-in-Aid for Scientific Research (no 26870765) from the Japan Society for the Promotion of Science and the Japan Foundation for Aging and Health.

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Correspondence to Naoki Saji.

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Supplementary Information accompanies the paper on Hypertension Research website

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Saji, N., Murotani, K., Shimizu, H. et al. Increased pulse wave velocity in patients with acute lacunar infarction doubled the risk of future ischemic stroke. Hypertens Res 40, 371–375 (2017). https://doi.org/10.1038/hr.2016.157

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Keywords

  • arterial stiffness
  • lacunar infarction
  • pulse wave velocity
  • recurrent stroke

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