Pub Date : 2026-02-01Epub Date: 2025-12-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108517
Jundong Hwang , Hyeon Sik Yang , Gi-Youn Kim , Regina EY Kim , Minho Lee , Donghyeon Kim , Jin Wook Choi , Woo Sang Jung , Kijeong Lee
Background
Computed tomography perfusion (CTP) is widely used to treat acute strokes. The affected brain volume, measured based on the threshold value in the calculated CTP map, has helped guide treatment decisions. We proposed a new software program developed for CTP analysis, SCALE-CTP, and compared the affected brain volumes estimated using RAPID and SCALE-CTP.
Methods
We recruited 362 individuals from the local hospital to evaluate the concordance between SCALE-CTP and RAPID in predicting affected brain volumes, including relative cerebral blood flow (rCBF) <30 % and time-to-maximum concentration (Tmax) > 6 s, and the mismatch volumes. Concordance correlation coefficients (CCC) and Bland–Altman plots were used to assess agreement. Subgroup analyses and comparisons with DWI-derived infarction areas were also performed, along with an evaluation of differences in clinical decision-making.
Results
The calculated volumes from two different software showed excellent concordance (rCBF < 30 % volume: 0.91, Tmax > 6s: 0.88 volume, mismatch volume: 0.82). The concordance between the two software programs remains excellent in the subgroup analysis. In the subset of 38 cases, the differences between DWI-derived infarction area and rCBF < 30 % volume from both software were similar, while SCALE-CTP showed more variability. Their differences in clinical decision making were slightly different.
Conclusion
SCALE-CTP demonstrated strong agreement with RAPID in predicting affected brain volumes and shows potential as a reliable tool for guiding hyperacute ischemic stroke treatment. Further validation is needed to confirm its clinical utility.
{"title":"A comparative analysis of SCALE-CTP and RAPID in determining the affected brain volumes of patients with ischemic stroke","authors":"Jundong Hwang , Hyeon Sik Yang , Gi-Youn Kim , Regina EY Kim , Minho Lee , Donghyeon Kim , Jin Wook Choi , Woo Sang Jung , Kijeong Lee","doi":"10.1016/j.jstrokecerebrovasdis.2025.108517","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108517","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography perfusion (CTP) is widely used to treat acute strokes. The affected brain volume, measured based on the threshold value in the calculated CTP map, has helped guide treatment decisions. We proposed a new software program developed for CTP analysis, SCALE-CTP, and compared the affected brain volumes estimated using RAPID and SCALE-CTP.</div></div><div><h3>Methods</h3><div>We recruited 362 individuals from the local hospital to evaluate the concordance between SCALE-CTP and RAPID in predicting affected brain volumes, including relative cerebral blood flow (rCBF) <30 % and time-to-maximum concentration (Tmax) > 6 s, and the mismatch volumes. Concordance correlation coefficients (CCC) and Bland–Altman plots were used to assess agreement. Subgroup analyses and comparisons with DWI-derived infarction areas were also performed, along with an evaluation of differences in clinical decision-making.</div></div><div><h3>Results</h3><div>The calculated volumes from two different software showed excellent concordance (rCBF < 30 % volume: 0.91, Tmax > 6s: 0.88 volume, mismatch volume: 0.82). The concordance between the two software programs remains excellent in the subgroup analysis. In the subset of 38 cases, the differences between DWI-derived infarction area and rCBF < 30 % volume from both software were similar, while SCALE-CTP showed more variability. Their differences in clinical decision making were slightly different.</div></div><div><h3>Conclusion</h3><div>SCALE-CTP demonstrated strong agreement with RAPID in predicting affected brain volumes and shows potential as a reliable tool for guiding hyperacute ischemic stroke treatment. Further validation is needed to confirm its clinical utility.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108517"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.jstrokecerebrovasdis.2026.108554
Jianfeng Qi , Zhimin Zhang , Jixiang Yin , Xuhui Yuan , Xu Wang , Zexiang Liu , Yuhang Liu , Jianjun Wang
Background
Pdcd4 is a potential target for intracerebral hemorrhage (ICH) treatment. This research intended to elucidate the mechanism by which Pdcd4 regulates ICH progression.
Methods
Male mice were infected with sh-Pdcd4 lentivirus, followed by injection of bacterial collagenase to establish an ICH model. Subsequent experiments, including brain water content assessment, neurological injury scoring, brain hematoma volume measurement, ELISA, HE staining, immunohistochemistry, Evans blue extravasation assay, and Western blot, were conducted to analyze the role of Pdcd4 in ICH. PI3K inhibitor LY294002 was employed to further investigate the potential mechanisms in vivo. bEnd.3 cells were infected with sh-Pdcd4 in the presence or absence of tunicamycin (an ER stress inducer), followed by hemoglobin treatment to mimic ICH in vitro. The effects of Pdcd4 on endoplasmic reticulum (ER) stress in ICH were evaluated through CCK-8, ELISA, and Western blot assays.
Results
Pdcd4 was upregulated in ICH mice, with the highest levels observed at 24 h. Pdcd4 knockdown markedly alleviated brain injury and neuroinflammation, inhibited ER stress, and upregulated PI3K/AKT pathway in ICH mice. These changes were partially reversed by LY294002. In bEnd.3 cells, Pdcd4 levels were significantly increased after hemoglobin treatment. Additionally, Pdcd4 knockdown significantly increased cell viability and inhibited inflammatory factor secretion and ER stress in the ICH group. This phenomenon was partially counteracted by tunicamycin. Furthermore, Pdcd4 knockdown markedly activated the PI3K/AKT pathway in the ICH group.
Conclusion
Pdcd4 knockdown alleviates ICH through PI3K/AKT pathway-mediated ER stress.
{"title":"Knockdown of programmed cell death 4 inhibits endoplasmic reticulum stress in male mice with intracerebral hemorrhage through the phosphoinositide 3-kinase/protein kinase B pathway","authors":"Jianfeng Qi , Zhimin Zhang , Jixiang Yin , Xuhui Yuan , Xu Wang , Zexiang Liu , Yuhang Liu , Jianjun Wang","doi":"10.1016/j.jstrokecerebrovasdis.2026.108554","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108554","url":null,"abstract":"<div><h3>Background</h3><div>Pdcd4 is a potential target for intracerebral hemorrhage (ICH) treatment. This research intended to elucidate the mechanism by which Pdcd4 regulates ICH progression.</div></div><div><h3>Methods</h3><div>Male mice were infected with sh-<em>Pdcd4</em> lentivirus, followed by injection of bacterial collagenase to establish an ICH model. Subsequent experiments, including brain water content assessment, neurological injury scoring, brain hematoma volume measurement, ELISA, HE staining, immunohistochemistry, Evans blue extravasation assay, and Western blot, were conducted to analyze the role of Pdcd4 in ICH. PI3K inhibitor LY294002 was employed to further investigate the potential mechanisms <em>in vivo</em>. bEnd.3 cells were infected with sh-<em>Pdcd4</em> in the presence or absence of tunicamycin (an ER stress inducer), followed by hemoglobin treatment to mimic ICH <em>in vitro</em>. The effects of Pdcd4 on endoplasmic reticulum (ER) stress in ICH were evaluated through CCK-8, ELISA, and Western blot assays.</div></div><div><h3>Results</h3><div>Pdcd4 was upregulated in ICH mice, with the highest levels observed at 24 h. <em>Pdcd4</em> knockdown markedly alleviated brain injury and neuroinflammation, inhibited ER stress, and upregulated PI3K/AKT pathway in ICH mice. These changes were partially reversed by LY294002. In bEnd.3 cells, Pdcd4 levels were significantly increased after hemoglobin treatment. Additionally, <em>Pdcd4</em> knockdown significantly increased cell viability and inhibited inflammatory factor secretion and ER stress in the ICH group. This phenomenon was partially counteracted by tunicamycin. Furthermore, <em>Pdcd4</em> knockdown markedly activated the PI3K/AKT pathway in the ICH group.</div></div><div><h3>Conclusion</h3><div><em>Pdcd4</em> knockdown alleviates ICH through PI3K/AKT pathway-mediated ER stress.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108554"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-02DOI: 10.1016/j.jstrokecerebrovasdis.2026.108543
Sijia Guo , Bo Qu , Qiqi Wang , Yan Sun
Objective
This study employs data from the Global Burden of Disease Study (GBD) 2021 to analyze the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of ischemic stroke (IS) attributable to smoking and high alcohol use from 1990 to 2021 across 204 countries and territories, stratified by Socio-demographic Index (SDI), region, sex, and age. Trends are assessed using estimated annual percentage change (EAPC), and future burdens are projected to 2050 using an autoregressive integrated moving average (ARIMA) model.
Results
Globally, the burden of IS attributable to both risk factors declined, with smoking consistently associated with higher ASMR and ASDR than high alcohol use. High-SDI regions showed the most substantial reductions, whereas low-SDI regions experienced stagnant or slightly increasing burdens. Southeast Asia was the only region with a rising trend in smoking-related IS, while Tropical Latin America achieved remarkable success in alcohol control. The burden was higher among males and older age groups for smoking, and more prominent in young and middle-aged adults for alcohol use. Projections suggested a continuing decline in high-SDI regions but limited improvement in low-SDI areas by 2050.
Conclusion
Significant geographic and demographic disparities persist in the IS burden attributable to smoking and high alcohol use. Targeted policy interventions—especially enhanced tobacco and alcohol control in low- and middle-SDI regions, along with focused strategies for males and high-risk age groups—are urgently needed to reduce the global burden of ischemic stroke.
{"title":"Global and regional burden of ischemic stroke attributable to smoking and high alcohol use from 1990 to 2021, with projections to 2050","authors":"Sijia Guo , Bo Qu , Qiqi Wang , Yan Sun","doi":"10.1016/j.jstrokecerebrovasdis.2026.108543","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108543","url":null,"abstract":"<div><h3>Objective</h3><div>This study employs data from the Global Burden of Disease Study (GBD) 2021 to analyze the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of ischemic stroke (IS) attributable to smoking and high alcohol use from 1990 to 2021 across 204 countries and territories, stratified by Socio-demographic Index (SDI), region, sex, and age. Trends are assessed using estimated annual percentage change (EAPC), and future burdens are projected to 2050 using an autoregressive integrated moving average (ARIMA) model.</div></div><div><h3>Results</h3><div>Globally, the burden of IS attributable to both risk factors declined, with smoking consistently associated with higher ASMR and ASDR than high alcohol use. High-SDI regions showed the most substantial reductions, whereas low-SDI regions experienced stagnant or slightly increasing burdens. Southeast Asia was the only region with a rising trend in smoking-related IS, while Tropical Latin America achieved remarkable success in alcohol control. The burden was higher among males and older age groups for smoking, and more prominent in young and middle-aged adults for alcohol use. Projections suggested a continuing decline in high-SDI regions but limited improvement in low-SDI areas by 2050.</div></div><div><h3>Conclusion</h3><div>Significant geographic and demographic disparities persist in the IS burden attributable to smoking and high alcohol use. Targeted policy interventions—especially enhanced tobacco and alcohol control in low- and middle-SDI regions, along with focused strategies for males and high-risk age groups—are urgently needed to reduce the global burden of ischemic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108543"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.jstrokecerebrovasdis.2025.108525
Zijie Wang , Xinwei Zhao , Yan Ma
<div><h3>Introduction</h3><div>Stroke is a major acute cerebrovascular disorder and a leading cause of disability and death, for which ageing is a key risk factor. However, individuals of the same chronological age differ markedly in cerebrovascular vulnerability. This study aimed to investigate the association between biological aging and stroke risk and prognosis using several validated aging metrics.</div></div><div><h3>Methods</h3><div>In NHANES 1999–2018, we derived the frailty index (FI), Klemera–Doubal age (KDMAge) and phenotypic age (PhenoAge) as alternative measures of biological aging. Logistic regression, tests for trend, restricted cubic splines and subgroup analyses were used to assess associations with stroke prevalence. Kaplan–Meier curves and Cox regression were applied to evaluate all-cause mortality among stroke survivors. In parallel, we conducted bidirectional two-sample Mendelian randomization (MR) using large genome-wide association studies to examine the potential causal effects of multiple biological aging indicators (four epigenetic age acceleration measures, telomere length, facial aging and FI) on stroke and its ischaemic subtypes, and the reverse effects of stroke on aging acceleration.</div></div><div><h3>Results</h3><div>Among 34,856 participants, higher FI, KDMAge and PhenoAge, as well as biological age acceleration, were associated with increased stroke risk; these associations remained significant in fully adjusted models. Dose–response analyses revealed non-linear relationships between biological aging metrics and stroke, with FI and PhenoAge showing J-shaped and KDMAge S-shaped patterns. In survival analyses of 1,167 stroke patients, PhenoAge acceleration and frailty status were significantly associated with reduced survival probability and higher all-cause mortality, whereas KDMAge acceleration showed weaker prognostic value. In MR analyses meta-analysing GIGASTROKE and MEGASTROKE, genetically predicted FI was associated with higher risk of stroke overall (OR = 1.57, 95 % CI: 1.36–1.83, <em>p</em> < 0.001) and with major ischaemic subtypes, while other aging clocks showed weaker or subtype-specific associations. Reverse MR indicated that stroke liability was associated with higher PhenoAge acceleration (OR = 1.54, 95 % CI: 1.12–2.12, <em>p</em> = 0.008), higher FI (OR = 1.11, 95 % CI: 1.05–1.17, <em>p</em> < 0.001) and accelerated facial aging (OR = 1.02, 95 % CI: 1.01–1.03, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>In a nationally representative sample, multiple biological aging indicators were associated with stroke and post-stroke all-cause mortality, and bidirectional MR supported a potential two-way relationship between biological aging and stroke. Among the evaluated metrics, FI showed the most robust and consistent associations with stroke risk and survival and provided the clearest and most stable genetic evidence compatible with a causal effect on stroke and its ischaemic subty
中风是一种主要的急性脑血管疾病,是致残和死亡的主要原因,其中衰老是一个关键的危险因素。然而,相同年龄的个体在脑血管易损性方面存在显著差异。本研究旨在通过几个有效的衰老指标来研究生物衰老与卒中风险和预后之间的关系。方法在NHANES 1999-2018中,我们导出了脆性指数(FI)、klemera - double年龄(KDMAge)和表型年龄(PhenoAge)作为生物衰老的替代指标。采用Logistic回归、趋势检验、受限三次样条和亚组分析来评估与卒中患病率的关系。应用Kaplan-Meier曲线和Cox回归评价脑卒中幸存者的全因死亡率。与此同时,我们利用大型全基因组关联研究进行了双向双样本孟德尔随机化(MR),以检验多种生物衰老指标(四种表观遗传年龄加速指标、端粒长度、面部衰老和FI)对中风及其缺血性亚型的潜在因果影响,以及中风对衰老加速的反向影响。结果在34,856名参与者中,较高的FI、KDMAge和PhenoAge以及生物年龄加速与卒中风险增加相关;这些关联在完全调整后的模型中仍然显著。剂量-反应分析显示生物老化指标与中风之间存在非线性关系,FI和PhenoAge呈j型,kdage呈s型。在1167例脑卒中患者的生存分析中,表型age加速和虚弱状态与生存率降低和全因死亡率升高显著相关,而KDMAge加速显示出较弱的预后价值。在对GIGASTROKE和MEGASTROKE进行的MR荟萃分析中,基因预测的FI与卒中总体风险较高(OR = 1.57, 95% CI: 1.36-1.83, p < 0.001)和主要缺血亚型相关,而其他衰老时钟显示较弱或亚型特异性关联。反向MR显示卒中易感性与较高的表型加速(OR = 1.54, 95% CI: 1.12-2.12, p = 0.008)、较高的FI (OR = 1.11, 95% CI: 1.05-1.17, p < 0.001)和面部加速老化(OR = 1.02, 95% CI: 1.01-1.03, p = 0.001)相关。结论:在一个具有全国代表性的样本中,多种生物衰老指标与脑卒中和脑卒中后全因死亡率相关,双向磁共振支持生物衰老与脑卒中之间潜在的双向关系。在评估的指标中,FI显示出与卒中风险和生存最强大和一致的关联,并提供了最清晰和最稳定的遗传证据,与卒中及其缺血性亚型的因果效应相一致。这些发现支持FI作为在卒中风险分层和二级预防中捕获生物衰老的实用工具,这一主张值得在前瞻性和介入性研究中进行测试。
{"title":"Association between biological aging and stroke and all-cause mortality: A population-based cross-sectional study and Mendelian randomization analysis","authors":"Zijie Wang , Xinwei Zhao , Yan Ma","doi":"10.1016/j.jstrokecerebrovasdis.2025.108525","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108525","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke is a major acute cerebrovascular disorder and a leading cause of disability and death, for which ageing is a key risk factor. However, individuals of the same chronological age differ markedly in cerebrovascular vulnerability. This study aimed to investigate the association between biological aging and stroke risk and prognosis using several validated aging metrics.</div></div><div><h3>Methods</h3><div>In NHANES 1999–2018, we derived the frailty index (FI), Klemera–Doubal age (KDMAge) and phenotypic age (PhenoAge) as alternative measures of biological aging. Logistic regression, tests for trend, restricted cubic splines and subgroup analyses were used to assess associations with stroke prevalence. Kaplan–Meier curves and Cox regression were applied to evaluate all-cause mortality among stroke survivors. In parallel, we conducted bidirectional two-sample Mendelian randomization (MR) using large genome-wide association studies to examine the potential causal effects of multiple biological aging indicators (four epigenetic age acceleration measures, telomere length, facial aging and FI) on stroke and its ischaemic subtypes, and the reverse effects of stroke on aging acceleration.</div></div><div><h3>Results</h3><div>Among 34,856 participants, higher FI, KDMAge and PhenoAge, as well as biological age acceleration, were associated with increased stroke risk; these associations remained significant in fully adjusted models. Dose–response analyses revealed non-linear relationships between biological aging metrics and stroke, with FI and PhenoAge showing J-shaped and KDMAge S-shaped patterns. In survival analyses of 1,167 stroke patients, PhenoAge acceleration and frailty status were significantly associated with reduced survival probability and higher all-cause mortality, whereas KDMAge acceleration showed weaker prognostic value. In MR analyses meta-analysing GIGASTROKE and MEGASTROKE, genetically predicted FI was associated with higher risk of stroke overall (OR = 1.57, 95 % CI: 1.36–1.83, <em>p</em> < 0.001) and with major ischaemic subtypes, while other aging clocks showed weaker or subtype-specific associations. Reverse MR indicated that stroke liability was associated with higher PhenoAge acceleration (OR = 1.54, 95 % CI: 1.12–2.12, <em>p</em> = 0.008), higher FI (OR = 1.11, 95 % CI: 1.05–1.17, <em>p</em> < 0.001) and accelerated facial aging (OR = 1.02, 95 % CI: 1.01–1.03, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>In a nationally representative sample, multiple biological aging indicators were associated with stroke and post-stroke all-cause mortality, and bidirectional MR supported a potential two-way relationship between biological aging and stroke. Among the evaluated metrics, FI showed the most robust and consistent associations with stroke risk and survival and provided the clearest and most stable genetic evidence compatible with a causal effect on stroke and its ischaemic subty","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108525"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-21DOI: 10.1016/j.jstrokecerebrovasdis.2025.108535
Chaitali Dagli , Nicole D. Armstrong , Daeeun Kim , Laura M. Raffield , Hemant K. Tiwari , Mary Cushman , Suzanne E. Judd , Michael Crowe , Virginia J. Howard , Marguerite R. Irvin
Background
African American (AA) adults have a high burden of late-life cognitive impairment (CI) and dementia but remain underrepresented in genetic epidemiology studies. Genetic risk and cardiometabolic diseases (CMDs) contribute to dementia risk. This study investigated whether genetic susceptibility and CMDs were associated with a composite CI outcome and whether CMDs modified these associations.
Methods
In AA participants within the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we assessed the association of a dementia polygenic risk score (PRS), APOE ε4 carrier status, and three prevalent CMDs: stroke, coronary artery disease (CAD), and type 2 diabetes (T2D) with a composite outcome of CI and dementia as a contributing cause of death (DCCD).
We used logistic regression adjusted for age, sex, education, income, body mass index, smoking status, alcohol intake, physical activity, hypertension, low-density lipoprotein, and C-reactive protein. Interaction terms were included to assess whether CMDs modified the associations between genetic risk and the composite outcome.
Results
Of 8,838 participants, 516 (5.84 %) developed CI or had DCCD. In fully adjusted models, high polygenic risk (highest vs lowest PRS tertile) was associated with increased odds of the composite outcome [odds ratio (OR): 1.42; 95 % confidence interval (CI): 1.12-1.78], as was APOE ε4 carrier status (OR: 1.46; 95% CI: 1.21-1.78). Among CMDs, stroke (OR: 1.45; 95% CI: 1.04-2.02) and T2D (OR: 1.31; 95% CI: 1.06-1.61) were significantly associated with increased odds of the composite outcome. However, the association between genetic risk and the composite outcome did not significantly differ by CMD status.
Conclusion
Genetic risk and CMDs independently contributed to dementia-related outcomes, indicating their relevance in understanding dementia risk among AA adults.
{"title":"Integration of genetic risk, cardiometabolic diseases, and cognitive impairment among African American adults","authors":"Chaitali Dagli , Nicole D. Armstrong , Daeeun Kim , Laura M. Raffield , Hemant K. Tiwari , Mary Cushman , Suzanne E. Judd , Michael Crowe , Virginia J. Howard , Marguerite R. Irvin","doi":"10.1016/j.jstrokecerebrovasdis.2025.108535","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108535","url":null,"abstract":"<div><h3>Background</h3><div>African American (AA) adults have a high burden of late-life cognitive impairment (CI) and dementia but remain underrepresented in genetic epidemiology studies. Genetic risk and cardiometabolic diseases (CMDs) contribute to dementia risk. This study investigated whether genetic susceptibility and CMDs were associated with a composite CI outcome and whether CMDs modified these associations.</div></div><div><h3>Methods</h3><div>In AA participants within the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we assessed the association of a dementia polygenic risk score (PRS), <em>APOE</em> ε4 carrier status, and three prevalent CMDs: stroke, coronary artery disease (CAD), and type 2 diabetes (T2D) with a composite outcome of CI and dementia as a contributing cause of death (DCCD).</div><div>We used logistic regression adjusted for age, sex, education, income, body mass index, smoking status, alcohol intake, physical activity, hypertension, low-density lipoprotein, and C-reactive protein. Interaction terms were included to assess whether CMDs modified the associations between genetic risk and the composite outcome.</div></div><div><h3>Results</h3><div>Of 8,838 participants, 516 (5.84 %) developed CI or had DCCD. In fully adjusted models, high polygenic risk (highest vs lowest PRS tertile) was associated with increased odds of the composite outcome [odds ratio (OR): 1.42; 95 % confidence interval (CI): 1.12-1.78], as was <em>APOE</em> ε4 carrier status (OR: 1.46; 95% CI: 1.21-1.78). Among CMDs, stroke (OR: 1.45; 95% CI: 1.04-2.02) and T2D (OR: 1.31; 95% CI: 1.06-1.61) were significantly associated with increased odds of the composite outcome. However, the association between genetic risk and the composite outcome did not significantly differ by CMD status.</div></div><div><h3>Conclusion</h3><div>Genetic risk and CMDs independently contributed to dementia-related outcomes, indicating their relevance in understanding dementia risk among AA adults.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108535"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-02DOI: 10.1016/j.jstrokecerebrovasdis.2026.108545
Leanna M Delhey PhD , Jon Zelner PhD , Xu Shi PhD , Lewis B Morgenstern MD , Devin L Brown MD , Melinda A Smith DrPH , Erin C Case BA , Lynda D Lisabeth PhD
Objective
: Assess associations between destinations near stroke survivor's residence – places like restaurants, recreation centers, and stores that offer opportunities for physical activity and socialization outside of the home and work – and their poststroke outcomes.
Methods
: We included non-Hispanic white and Mexican American incident stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Texas. Exposure: count of destinations within 0.5-miles around survivors’ residences. Outcomes assessed at approximately 3-, 6-, and 12-months poststroke: cognition (Modified Mini-Mental State Examination), functioning (activities of daily living (ADL)/instrumental ADL), health-related quality of life (abbreviated Stroke-Specific Quality of Life scale), and depression (Patient Health Questionnaire-8). We fit adjusted linear mixed models and considered interactions with follow-up time and stroke severity (NIH stroke scale - mild (<5), moderate-severe (≥5)).
Results
: We included 1,786 survivors who completed 3 (N = 1,321), 6 (N = 677), or 12-month interviews (N = 652). Median age was 64 years, 55% male, and 74% mild stroke. Stroke severity modified associations with functioning (p = 0.09) and quality of life (p = 0.05), follow-up time did not (p > 0.25). Among moderate-severe stroke survivors, more destinations were associated with more favorable functioning (mean difference=-0.12, 95% CI=-0.22, -0.01) and quality of life (mean difference=0.16, 95% CI=0.03, 0.30). No associations were observed among mild stroke survivors or with cognition or depression (p > 0.05).
Interpretation
: Among moderate-severe stroke survivors, more nearby destinations were associated with more favorable functioning and quality of life in the first year. Future research is needed to explore if specific types of destinations may support more favorable outcomes.
{"title":"Access to neighborhood destinations that offer opportunities for physical activity and socialization is associated with favorable post-stroke outcomes","authors":"Leanna M Delhey PhD , Jon Zelner PhD , Xu Shi PhD , Lewis B Morgenstern MD , Devin L Brown MD , Melinda A Smith DrPH , Erin C Case BA , Lynda D Lisabeth PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108545","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108545","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> Assess associations between destinations near stroke survivor's residence – places like restaurants, recreation centers, and stores that offer opportunities for physical activity and socialization outside of the home and work – and their poststroke outcomes.</div></div><div><h3>Methods</h3><div><strong>:</strong> We included non-Hispanic white and Mexican American incident stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Texas. Exposure: count of destinations within 0.5-miles around survivors’ residences. Outcomes assessed at approximately 3-, 6-, and 12-months poststroke: cognition (Modified Mini-Mental State Examination), functioning (activities of daily living (ADL)/instrumental ADL), health-related quality of life (abbreviated Stroke-Specific Quality of Life scale), and depression (Patient Health Questionnaire-8). We fit adjusted linear mixed models and considered interactions with follow-up time and stroke severity (NIH stroke scale - mild (<5), moderate-severe (≥5)).</div></div><div><h3>Results</h3><div><strong>:</strong> We included 1,786 survivors who completed 3 (<em>N</em> = 1,321), 6 (<em>N</em> = 677), or 12-month interviews (<em>N</em> = 652). Median age was 64 years, 55% male, and 74% mild stroke. Stroke severity modified associations with functioning (<em>p</em> = 0.09) and quality of life (<em>p</em> = 0.05), follow-up time did not (<em>p</em> > 0.25). Among moderate-severe stroke survivors, more destinations were associated with more favorable functioning (mean difference=-0.12, 95% CI=-0.22, -0.01) and quality of life (mean difference=0.16, 95% CI=0.03, 0.30). No associations were observed among mild stroke survivors or with cognition or depression (<em>p</em> > 0.05).</div></div><div><h3>Interpretation</h3><div><strong>:</strong> Among moderate-severe stroke survivors, more nearby destinations were associated with more favorable functioning and quality of life in the first year. Future research is needed to explore if specific types of destinations may support more favorable outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108545"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-03DOI: 10.1016/j.jstrokecerebrovasdis.2026.108540
Li Hou , Jing Tang , Lei Zhang , Yanhong Li , Yao Niu
Objective
To evaluate the relationship between the longitudinal changes of the triglyceride-glucose (TyG) index and the incidence of cardio-cerebral vascular diseases (CCVD) among individuals with CKM syndrome stages 0-3.
Methods
Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study included 3,416 participants aged 45 and above. Participants were categorized into different TyG trajectory groups using k-means clustering analysis. Logistic regression and restricted cubic spline (RCS) models were employed to assess the associations between cumTyG and TyG changes with CCVD incidence.
Results
Over a median follow-up of 5 years, 698 participants developed CCVD. The relationship between cumTyG and CCVD risk was linear in RCS regression. After adjusting for potential confounders, the risk of CCVD was found to be significantly higher for participants in Class 2, Class 4, and Class 5 compared to those in Class 1. Specifically, Class 2 had an odds ratio (OR) of 1.45 (95% confidence interval [CI]: 1.14, 1.84), Class 4 had an OR of 1.42 (95% CI: 1.09, 1.86), and Class 5 had an OR of 1.64 (95% CI: 1.14, 2.34). Additionally, an elevated cumTyG index was associated with an increased risk of CCVD, with an OR of 1.13 (95% CI: 1.05, 1.22, P=0.002).
Conclusion
CumTyG and its longitudinal trend are independent and potent predictors of CCVD in patients with stage 1–3 CKM syndrome. Dynamic monitoring of the TyG trajectory can enable the early identification of high-risk individuals, providing reliable evidence for individualized and cost-effective prevention.
{"title":"Association between cumulative changes of the triglyceride glucose index and incidence of Cardio-cerebral vascular diseases in a population with cardiovascular-kidney-metabolic syndrome stage 0–3: a nationwide prospective cohort study","authors":"Li Hou , Jing Tang , Lei Zhang , Yanhong Li , Yao Niu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108540","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108540","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the relationship between the longitudinal changes of the triglyceride-glucose (TyG) index and the incidence of cardio-cerebral vascular diseases (CCVD) among individuals with CKM syndrome stages 0-3.</div></div><div><h3>Methods</h3><div>Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study included 3,416 participants aged 45 and above. Participants were categorized into different TyG trajectory groups using k-means clustering analysis. Logistic regression and restricted cubic spline (RCS) models were employed to assess the associations between cumTyG and TyG changes with CCVD incidence.</div></div><div><h3>Results</h3><div>Over a median follow-up of 5 years, 698 participants developed CCVD. The relationship between cumTyG and CCVD risk was linear in RCS regression. After adjusting for potential confounders, the risk of CCVD was found to be significantly higher for participants in Class 2, Class 4, and Class 5 compared to those in Class 1. Specifically, Class 2 had an odds ratio (OR) of 1.45 (95% confidence interval [CI]: 1.14, 1.84), Class 4 had an OR of 1.42 (95% CI: 1.09, 1.86), and Class 5 had an OR of 1.64 (95% CI: 1.14, 2.34). Additionally, an elevated cumTyG index was associated with an increased risk of CCVD, with an OR of 1.13 (95% CI: 1.05, 1.22, P=0.002).</div></div><div><h3>Conclusion</h3><div>CumTyG and its longitudinal trend are independent and potent predictors of CCVD in patients with stage 1–3 CKM syndrome. Dynamic monitoring of the TyG trajectory can enable the early identification of high-risk individuals, providing reliable evidence for individualized and cost-effective prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108540"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-17DOI: 10.1016/j.jstrokecerebrovasdis.2025.108529
Yangfang An , Biao Wang , Jiali Zhao , Hui Zhou , Qiong Zhou
Objective
Mitochondrial dysfunction is a key determinant of neuronal death and a promising therapeutic target in ischemic stroke. Dl-3-n-butylphthalide (NBP), an approved neuroprotective agent in China, has been shown to improve mitochondrial integrity, yet its precise molecular mechanisms remain unclear. This study aimed to determine whether NBP exerts neuroprotection by upregulating mitochondrial cytochrome c oxidase subunit 1 (MT-CO1) and to clarify the contribution of MT-CO1 to mitochondrial function recovery.
Methods
MT-CO1 expression was measured in the circulation from acute ischemic stroke participants before and following NBP therapy. In SH-SY5Y cells under OGD/R treatment, the action of NBP on mitochondrial bioenergetics, oxidative stress, and apoptosis were assessed. MT-CO1 knockdown was used to determine mechanistic involvement.
Results
NBP significantly increased MT-CO1 expression both in vivo and in vitro, improved mitochondrial membrane voltage and ATP production, reduced ROS generation, and decreased apoptosis. MT-CO1 silencing markedly attenuated these protective effects.
Conclusion
NBP protects against ischemia-induced mitochondrial dysfunction partly through MT-CO1 upregulation, supporting MT-CO1 as a potential therapeutic target for mitochondrial function protection in ischemic stroke.
{"title":"Dl-3-n-butylphthalide protects against ischemic stroke by enhancing mitochondrial function via MT-CO1 upregulation","authors":"Yangfang An , Biao Wang , Jiali Zhao , Hui Zhou , Qiong Zhou","doi":"10.1016/j.jstrokecerebrovasdis.2025.108529","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108529","url":null,"abstract":"<div><h3>Objective</h3><div>Mitochondrial dysfunction is a key determinant of neuronal death and a promising therapeutic target in ischemic stroke. Dl-3-n-butylphthalide (NBP), an approved neuroprotective agent in China, has been shown to improve mitochondrial integrity, yet its precise molecular mechanisms remain unclear. This study aimed to determine whether NBP exerts neuroprotection by upregulating mitochondrial cytochrome c oxidase subunit 1 (MT-CO1) and to clarify the contribution of MT-CO1 to mitochondrial function recovery.</div></div><div><h3>Methods</h3><div>MT-CO1 expression was measured in the circulation from acute ischemic stroke participants before and following NBP therapy. In SH-SY5Y cells under OGD/R treatment, the action of NBP on mitochondrial bioenergetics, oxidative stress, and apoptosis were assessed. MT-CO1 knockdown was used to determine mechanistic involvement.</div></div><div><h3>Results</h3><div>NBP significantly increased MT-CO1 expression both <em>in vivo</em> and <em>in vitro</em>, improved mitochondrial membrane voltage and ATP production, reduced ROS generation, and decreased apoptosis. MT-CO1 silencing markedly attenuated these protective effects.</div></div><div><h3>Conclusion</h3><div>NBP protects against ischemia-induced mitochondrial dysfunction partly through MT-CO1 upregulation, supporting MT-CO1 as a potential therapeutic target for mitochondrial function protection in ischemic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108529"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The association between post stroke epilepsy (PSE) and revascularization therapy in stroke patients remains controversial. The prognostic significance of other supportive techniques such as Computed Tomography (CT) brain data and electroencephalograph (EEG) in PSE prediction is poorly understood.
Methods
We performed a single-center prospective observational study to evaluate the incidence of acute symptomatic seizures (ASS) and PSE in adult patients affected by acute ischaemic stroke undergoing reperfusional approaches compared to non-revascularized patients, with a 30-months follow-up.
Results
We enrolled 258 patients with stroke: 155 cases (treated with intravenous tissue plasminogen activator (IV-tPA)) and/or endovascular thrombectomy (ET) and 103 controls (non-revascularized). The global incidence of ASS was 3.4%, while PSE was diagnosed in 5% of patients. Reperfusion treatments were not associated with increased risk of ASS or PSE. Hemorrhagic infarction was found as the only independent risk factor for PSE development (HR 5.33, (95% CI, 1.69 – 16.82), p=0.004). In parallel, we analyzed the relationship between ASS and hemorrhagic infarction using the chi-square test (OR 8.59 (95% CI, 2.19 - 33.7), p < 0.001).
Conclusion
Reperfusion therapies for acute ischemic stroke do not increase the risk of epilepsy during the first 30 months after stroke. Hemorrhagic infarction was the main risk for epilepsy after stroke.
{"title":"Post-stroke epilepsy in revascularized versus not revascularized stroke patients: A prospective cohort study","authors":"Stefania Lazzari , Carlotta Mutti , Francesca Bozzetti , Antonio Genovese , Maddalena Frapporti , Francesca Badini , Carmine Siniscalchi , Andrea Becciolini , Valentina Tontini , Elisa Mannini , Irene Florindo , Francesco Misirocchi , Francesca Iuculano , Liborio Parrino , Lucia Zinno","doi":"10.1016/j.jstrokecerebrovasdis.2026.108544","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108544","url":null,"abstract":"<div><h3>Objective</h3><div>The association between post stroke epilepsy (PSE) and revascularization therapy in stroke patients remains controversial. The prognostic significance of other supportive techniques such as Computed Tomography (CT) brain data and electroencephalograph (EEG) in PSE prediction is poorly understood.</div></div><div><h3>Methods</h3><div>We performed a single-center prospective observational study to evaluate the incidence of acute symptomatic seizures (ASS) and PSE in adult patients affected by acute ischaemic stroke undergoing reperfusional approaches compared to non-revascularized patients, with a 30-months follow-up.</div></div><div><h3>Results</h3><div>We enrolled 258 patients with stroke: 155 cases (treated with intravenous tissue plasminogen activator (IV-tPA)) and/or endovascular thrombectomy (ET) and 103 controls (non-revascularized). The global incidence of ASS was 3.4%, while PSE was diagnosed in 5% of patients. Reperfusion treatments were not associated with increased risk of ASS or PSE. Hemorrhagic infarction was found as the only independent risk factor for PSE development (HR 5.33, (95% CI, 1.69 – 16.82), p=0.004). In parallel, we analyzed the relationship between ASS and hemorrhagic infarction using the chi-square test (OR 8.59 (95% CI, 2.19 - 33.7), p < 0.001).</div></div><div><h3>Conclusion</h3><div>Reperfusion therapies for acute ischemic stroke do not increase the risk of epilepsy during the first 30 months after stroke. Hemorrhagic infarction was the main risk for epilepsy after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108544"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.jstrokecerebrovasdis.2025.108532
Kati Lainelehto MD , Juha-Pekka Pienimäki MD, PhD , Sirpa Savilahti MD, PhD , Heini Huhtala MSc , Tomi Sarkanen MD, PhD , Heikki Numminen MD, PhD , Jukka Putaala MD, PhD
Background and aims
Atrial fibrillation (AF) and atherosclerosis in the arteries supplying the brain are both strong risk factors of ischemic cerebrovascular events. However, the effect of their concurrent presence on long-term mortality in patients with acute ischemic stroke or transient ischemic attack (TIA) has gone little studied.
Methods
A total of 406 patients with acute ischemic stroke or TIA were enrolled in a tertiary university center and their cervicocerebral arteries imaged with computed tomography angiography (CTA). The extent of atherosclerosis in the carotid, vertebral and intracranial arteries were rated as Cervicocerebral Atherosclerotic Burden (CAB) score. Furthermore, we assessed the combined effect of atherosclerosis and AF with a variable including AF status and CAB score in quartiles.
Results
After a median follow-up of 7.3 years (interquartile range 5.7-7.6), 62 of the 121 patients with AF had died, compared to 74 of 285 patients without AF (cumulative mortality rate 52.0 %, 95 % CI 47.1-56.9 % vs. 27.0 %, 24.7-29.3 %, respectively). In adjusted Cox regression, the two highest CAB score quartiles were associated with mortality in AF patients with hazard ratios of 12.7 (1.6-99.7) and 15.8 (2.0-126.4), respectively. Furthermore, with combined variable of AF and CAB score the risk of death was 3-fold in AF patients with two highest quartiles of CAB score compared to those without AF in the two lowest CAB score quartiles.
Conclusions
The total atherosclerotic burden in arteries supplying the brain appears as a strong independent factor increasing long-term mortality in patients with acute ischemic stroke or TIA and concurrent AF.
{"title":"Cervicocerebral atherosclerosis and atrial fibrillation increase long-term mortality in patients with ischemic stroke","authors":"Kati Lainelehto MD , Juha-Pekka Pienimäki MD, PhD , Sirpa Savilahti MD, PhD , Heini Huhtala MSc , Tomi Sarkanen MD, PhD , Heikki Numminen MD, PhD , Jukka Putaala MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108532","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108532","url":null,"abstract":"<div><h3>Background and aims</h3><div>Atrial fibrillation (AF) and atherosclerosis in the arteries supplying the brain are both strong risk factors of ischemic cerebrovascular events. However, the effect of their concurrent presence on long-term mortality in patients with acute ischemic stroke or transient ischemic attack (TIA) has gone little studied.</div></div><div><h3>Methods</h3><div>A total of 406 patients with acute ischemic stroke or TIA were enrolled in a tertiary university center and their cervicocerebral arteries imaged with computed tomography angiography (CTA). The extent of atherosclerosis in the carotid, vertebral and intracranial arteries were rated as Cervicocerebral Atherosclerotic Burden (CAB) score. Furthermore, we assessed the combined effect of atherosclerosis and AF with a variable including AF status and CAB score in quartiles.</div></div><div><h3>Results</h3><div>After a median follow-up of 7.3 years (interquartile range 5.7-7.6), 62 of the 121 patients with AF had died, compared to 74 of 285 patients without AF (cumulative mortality rate 52.0 %, 95 % CI 47.1-56.9 % vs. 27.0 %, 24.7-29.3 %, respectively). In adjusted Cox regression, the two highest CAB score quartiles were associated with mortality in AF patients with hazard ratios of 12.7 (1.6-99.7) and 15.8 (2.0-126.4), respectively. Furthermore, with combined variable of AF and CAB score the risk of death was 3-fold in AF patients with two highest quartiles of CAB score compared to those without AF in the two lowest CAB score quartiles.</div></div><div><h3>Conclusions</h3><div>The total atherosclerotic burden in arteries supplying the brain appears as a strong independent factor increasing long-term mortality in patients with acute ischemic stroke or TIA and concurrent AF.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108532"},"PeriodicalIF":1.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}