Atherosclerosis and microangiopathy of the coronary

Atherosclerosis and microangiopathy of the coronary, peripheral and cerebral arteries are frequently a complication of diabetes. The relative risk of ischemic stroke ranges from 1.5 to 3.0 and probably depends on the type and severity of the diabetes. Recent cohort studies have demonstrated an independent effect of diabetes even after controlling for other stroke risk factors.

Abnormalities of serum lipids, triglyceride, cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) are regarded as risk factors, more for coronary artery disease than cerebrovascular disease. Degree and progression of carotid atherosclerosis have been found to be directly related to cholesterol and LDL, and inversely related to HDL. Most recently, high serum lipoprotein(a) was found to be a risk factor in a group of patients with early onset of cerebral infarction. The absence of a consistent significant relationship between cholesterol and stroke may be partially explained by the recognition that there are multiple stroke subtypes which are not all attributed to atherosclerosis.

Cigarette smoking has been clearly established as a biologically plausible, independent determinant of stroke. In case-control studies the effect of cigarette smoking remained significant after adjustment for other factors, and a dose-response relationship was apparent. In cohort studies, cigarette smoking was an independent predictor of ischemic stroke. For different stroke types, the stroke risk attributed to cigarette smoking was greatest for subarachnoid hemorrhage, intermediate for cerebral infarction, and lowest for cerebral hemorrhage.

The role of alcohol as a stroke risk factor is controversial. Results ranged from a definite independent effect in both men and women, an effect only in men, and no effect after controlling for other confounding risk factors such as cigarette smoking. The various mechanisms through Which the risk of stroke may be increased include hypertension, hypercoagulable states, cardiac arrhythmias, and cerebral blood flow reductions. Order cheap spermamax at online canadian pharmacy. However, there is also evidence that light to moderate drinking can increase HDL-cholesterol and reduce the risk of coronary artery disease. A J-shaped relationship between alcohol and stroke has been observed with an elevated stroke risk for moderate to heavy alcohol consumption and a protective effect in light drinkers when compared to non-drinkers. In Northern Manhattan, heavy alcohol use was associated with an increased risk of stroke recurrence within 5 years of ischemic stroke even after controlling for hypertension and hyperglycemia.

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