Hyperlipidemias: Bogousslavsky J

Leys D, Kwiecinski H, Bogousslavsky J, Bath P, Brainin M, Diener HC, Kaste M, Sivenius J, Hennerici MG, Hacke W, Anonymous00185, Anonymous00186. · No affiliation provided · Cerebrovasc Dis. · Pubmed #14707404 No free full text.

This publication has no abstract.

Piechowski-Jóźwiak B, Bogousslavsky J. · Department of Neurology, CHUV, Lausanne, Switzerland. · Acta Neurol Belg. · Pubmed #16076057 No free full text.

Abstract: Diabetes mellitus, arterial hypertension, smoking are major stroke risk factors. The role of hypercholesterolemia in stroke has not been established yet. In patients with type 2 diabetes mellitus there is evidence that intensive glucose lowering therapy diminishes the risk of microvascular complications. In all patients with stroke or transient ischemic attack (TIA), blood pressure should be lowered irrespectively of the baseline level with either diuretics, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, or calcium antagonists. The role of angiotensin II (AT2) receptor blockers has not been established so far. In general terms a global approach to management of patients with vascular risk factors should be developed. An extended follow-up of randomised trials on preventive therapy should be completed. Controlled trials comparing angiotensin receptor blockers with ACE inhibitors should be started. Further research may focus on the new lipid lowering agents, and on the comparison of single lipid lowering agent vs. combinations in stroke prevention. These efforts should help in finding the best vasoprotective strategy in stroke prevention.

Piechowski-Jozwiak B, Bogousslavsky J. · Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · Expert Rev Neurother. · Pubmed #15853564 No free full text.

Abstract: Despite great progress in the medical sciences, the effects of stroke in the modern world are profound, both in the aspect of death and disability it causes, as well as the economic demands it poses. The most important modifiable risk factors of stroke are arterial hypertension, heart disease, cigarette smoking and transient ischemic attacks. Secondary risk factors include hyperlipidemia, obesity and physical inactivity. The role of lipids in atherosclerosis and cerebral vascular events, and the influence of lipid-lowering therapies on stroke occurrence is a subject of debate in the medical literature. The aim of this review is to answer the basic question of whether lipid-lowering therapy should be used routinely in stroke prevention.

Devuyst G, Bogousslavsky J. · Service de neurologie, CHUV, Lausanne. · Schweiz Med Wochenschr. · Pubmed #11005106 No free full text.

Abstract: Atherosclerosis is the most common cause of vascular diseases, but the relevance of cholesterol has only been definitely associated with coronary artery disease and peripheral vascular disease. In comparison, the role of cholesterol in stroke is, while a tempting assumption, subject to controversy in the literature. The crucial question--is cholesterol a risk factor for stroke?--remains open. Recent trials with statin drugs, such as 4 S, CARE, LIPID and WOSCOP, have created a new wave of enthusiasm by showing decreased risk of stroke in the statin-treated patients. However, these trials are most often designed for patients with a known history of coronary artery disease. In contrast, studies investigating the impact of statins in the secondary prevention of stroke are still lacking. Moreover, the beneficial effects of statins on clinical events may involve non-cholesterol mechanisms. In regard to stroke prevention, there is no absolute evidence to recommend the use of statin drug therapy.

Carrera E, Maeder-Ingvar M, Rossetti AO, Devuyst G, Bogousslavsky J, Anonymous00434. · Department of Neurology, University Hospital Lausanne, Lausanne, Switzerland. · Cerebrovasc Dis. · Pubmed #17519551 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The Lausanne Stroke Registry includes, from 1979, all patients admitted to the department of Neurology of the Lausanne University Hospital with the diagnosis of first clinical stroke. Using the Lausanne Stroke Registry, we aimed to determine trends in risk factors, causes, localization and inhospital mortality over 25 years in hospitalized stroke patients. METHODS: We assessed temporal trends in stroke patients characteristics through the following consecutive periods: 1979-1987, 1988-1995 and 1996-2003. Age-adjusted cardiovascular risk factors, etiologies, stroke localizations and mortality were compared between the three periods. RESULTS: Overall, 5,759 patients were included. Age was significantly different among the analyzed periods (p < 0.001), showing an increment in older patients throughout time. After adjustment for age, hypercholesterolemia increased (p < 0.001), as opposed to cigarette smoking (p < 0.001), hypertension (p < 0.001) and diabetes and hyperglycemia (p < 0.001). In patients with ischemic strokes, there were significant changes in the distribution of causes with an increase in cardioembolic strokes (p < 0.001), and in the localization of strokes with an increase in entire middle cerebral artery (MCA) and posterior circulation strokes together with a decrease in superficial middle cerebral artery stroke (p < 0.001). In patients with hemorrhagic strokes, the thalamic localizations increased, whereas the proportion of striatocapsular hemorrhage decreased (p = 0.022). Except in the older patient group, the mortality rate decreased. CONCLUSIONS: This study shows major trends in the characteristics of stroke patients admitted to a department of neurology over a 25-year time span, which may result from referral biases, development of acute stroke management and possibly from the evolution of cerebrovascular risk factors.

Croquelois A, Bogousslavsky J. · Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. · J Neurol Neurosurg Psychiatry. · Pubmed #16549417 links to  free full text

Abstract: BACKGROUND: Secondary prevention of stroke has been shown to dramatically reduce recurrence and has been described as suboptimal. OBJECTIVE: To analyse patients' awareness and knowledge about cerebrovascular risk factors (CVRF) and their influence on CVRF control. METHODS: Patients (n = 164) who were attending a stroke outpatient clinic for the first time after hospital discharge (3 months) for a first stroke were asked to answer a short questionnaire including questions on awareness and knowledge of CVRF, visits to a CVRF specialist, number of visits to a general practitioner, adherence to drug treatments, cigarette smoking and cessation. RESULTS: CVRF were spontaneously mentioned as relevant for their stroke by only 13% of patients. A specialist was visited by only one-third of the patients and a general practitioner was not visited at all by 27% of the patients since their stroke. Awareness was inversely correlated with older age and good recovery. More than half of the patients had high blood pressure (> or = 140 mmHg for systolic and > or = 90 mmHg for diastolic values) at the time of follow-up. These high values were correlated with poor awareness. Appropriate secondary stroke prevention measures were not received by one-fourth of the patients; this was also correlated with poor awareness. CONCLUSIONS: CVRF control is not optimal and is at least partially related to patients' awareness and knowledge and suboptimal medical follow-up. Older patients and patients with excellent recovery are at particular risk for poor awareness and CVRF control.

Devuyst G, Karapanayiotides T, Hottinger I, Van Melle G, Bogousslavsky J. · Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · Neurology. · Pubmed #12874411 No free full text.

Abstract: In a case-control study, patients (n = 43/3,628) presenting seizures <1 week before (n = 6), < or =3 hours after (n = 26), and 3 to 24 hours after (n = 11) a first-ever stroke were studied. On multivariate analysis, they were characterized by lower levels of serum cholesterol (5.86 +/- 0.51 vs 6.34 +/- 0.58; p < 0.0001). Mortality and functional outcome at discharge were not influenced. Early poststroke seizures occur mainly during the critical 3-hour window for thrombolysis. Hypercholesterolemia appears to protect against seizures and cerebral ischemia.