Condition State Management: Stroke Watch

Low-Dose Aspirin Does Not Significantly Reduce Risk of Stroke

Aspirin may not reduce a person’s risk of ischemic stroke, according to a secondary analysis of the ASPREE trial (NCT01038583), which was published in the Journal of the American Medical Association. Daily low-dose aspirin was associated with an increased risk of intracranial bleeding.

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The study enrolled 19,114 participants (mostly older adults) from the United States and Australia, evaluating daily aspirin vs placebo for different types of stroke. Ischemic stroke occurred in 146 patients in the aspirin arm compared with 166 in the placebo arm (HR, 0.89; 95% CI, 0.71-1.11). In addition, hemorrhagic stroke (intracranial bleeding) occurred in 49 patients on aspirin compared with 37 on placebo (HR, 1.33; 95% CI, 0.87-2.04; P =.19).

There were 59 individuals (0.6%) in the aspirin arm who experienced other types of intracranial bleeding compared with 41 (0.4%) in the placebo arm. However, a significantly higher percentage of patients treated with aspirin experienced either hemorrhagic stroke or other types of intracranial bleeding (1.1%) compared with placebo (0.8%) (HR, 1.38; 95% CI, 1.03-1.84; P = .03).

Overall, the study found that low-dose daily aspirin can significantly increase the risk of intracerebral hemorrhagic events, particularly in an older population that is susceptible to bleeding-inducing events, compared with an insignificant link to reduced ischemic stroke events. Low-dose aspirin, which was thought to be effective as a secondary stroke prevention, “should not be prescribed for primary prevention in healthy older adults,” study authors wrote.—Luke Halpern

Intense Intervention Can Reduce Stroke Risk Factors in Black Adults

Black adults may have a higher risk of stroke compared with non-Black adults, according to a recent retrospective analysis conducted by the American Heart Association (AHA) that was published in Stroke.

Study coauthor Ashley Nelson, DO, said lifestyle coaching, providing necessary medication alterations or additions, and increasing accessibility to routine health care support and physician follow-ups can decrease the disparities in stroke risk.

The analysis looked at data from the 2008 to 2011 SAMMPRIS study (NCT00576693), which showed that aggressive medical management is superior to stenting for recurrent stroke prevention.

AHA investigators compared how intervention impacted patient medication use and cardiovascular risk factors: systolic and diastolic blood pressure; blood glucose levels; and physical activity (based on Physician centered Assessment and Counseling for Exercise [PACE] score) between Black and non-Black adults who had a stroke.

With 1 year of intervention, including regular follow-up visits with the health care team, lifestyle coaching, and intensive control of vascular risk factors, the average PACE score of Black adults increased from 2.7 to 4.2. In addition, a higher number of Black patients decreased their diastolic blood pressure compared with non-Black patients.—Erin Hunter

Insomnia Symptoms May Be Linked to Risk of Stroke in Adults

Insomnia symptoms may be linked to a greater risk of stroke, particularly among individuals younger than age 50, according to research published in Neurology.

The risk of stroke was 4-fold in patients younger than 50 years who had a higher number of symptoms of insomnia compared with those who did not have insomnia symptoms. People with 1 to 4 (less severe) symptoms

of insomnia still had a 16% increased risk of stroke compared with people with no symptoms after adjusting for age, alcohol use, smoking, and level of physical activity.

Investigators conducted the study to understand the link between the symptoms of insomnia and risk of stroke. The study comprised 31,126 participants (average age, 61 years) with no history of stroke at the study onset. The patients answered questions about the frequency of trouble falling asleep, waking up during the night, waking up too early, not being able to return to sleep, and feeling rested in the morning.

Investigators evaluated the responses, ranking symptom severity on a scale of 1 (less severe) to 8 (more severe). Among the participants, 6282 had no insomnia symptoms; 19,149 had 1 to 4 symptoms; and 5695 had 5 to 8 symptoms. However, those 50 years or older with 5 to 8 symptoms still had a 38% increased risk of stroke compared with those with no symptoms.

Handling insomnia symptoms at a younger age could be effective for stroke prevention, but further research should explore the reduction of stroke risk through management of sleeping problems.—Kennedy Ferruggia

References

1. Cloud GC, Williamson JD, Thao LTP, et al. Low-dose aspirin and the risk of stroke and intracerebral bleeding in healthy older people: secondary analysis of a randomized clinical trial. JAMA Netw Open. 2023;6(7):e2325803. doi:10.1001/jamanetworkopen.2023.25803
2. Disparities in Black adults’ stroke risk factors persist; risk factor control reduced gap. News release. American Heart Association. August 3, 2023. Accessed August 3, 2023. https://www.eurekalert.org/news-releases/997143
3. Trouble falling asleep, staying asleep linked to increased risk of stroke. News release. American Academy of Neurology. June 7, 2023. Accessed August 3, 2023. https://www.aan.com/PressRoom/Home/PressRelease/5090