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Highlights from July Stroke: Journal of the American Heart Association

American Heart Association

Acetaminophen reduces body temperature after ischemic stroke

DALLAS - For the first time, research has shown that high doses of acetaminophen can lower body temperature and may limit the debilitating effects of stroke, even in patients who don't have a fever, researchers report in the July issue of Stroke: Journal of the American Heart Association.

Fever in the first 12 to 24 hours after a stroke is a strong predictor of how severe the effects of the stroke will be. However, it is unknown if fever-reducing drugs, such as acetaminophen, can be helpful, even if patients do not have a fever. Some research has examined ways to induce hypothermia (lowered body temperature) in some feverish stroke patients.

In the first randomized, double-blind clinical trial, Dutch researchers investigated if early use of the drug acetaminophen in those who had an ischemic stroke but did not always have fever, would reduce body temperature. An ischemic stroke is caused by a blood clot that reduces blood flow to the brain. The study compared 75 patients with ischemic stroke whose temperatures were between 36 degrees Celsius (96.8 degrees Fahrenheit) and 39 degrees Celsius (102.2 F). They were treated with acetaminophen or placebo six times a day for five days.

Individuals treated with the higher dose of acetaminophen had temperatures 0.4 degrees Celsius (.72 F) lower than placebo treatment after 24 hours of treatment. By day five, there were no differences in temperatures between any of the groups.

The researchers note that the small initial drop in temperature is significant considering that a previous observational study suggested a two-fold increase in the risk of death for every one degree Celsius rise in body temperature.

Acetaminophen's effect on temperature may be worthwhile, given the low cost and safety of the drug, the researchers note. Their next, larger study will be directed at demonstrating the effect of acetaminophen on stroke outcomes. These results may also prompt more research into medical means to decrease stroke and improve outcomes.

D. W. J. Dippel, M.D., neurologist, University Hospital Rotterdam, Rotterdam, the Netherlands, 31-10-4639-222; e-mail: dippel@neuro.fgg.eur.nl.

Negative attitude hastens death of stroke survivors

DALLAS - Negative attitude may hasten death in individuals who have suffered a stroke, according to a report in the July issue of Stroke: Journal of the American Heart Association.

Surprisingly, depression and anxiety were not linked to a shorter lifespan. Researchers in Scotland found that those with a fatalistic attitude - that is, they feel they can do nothing to help themselves - die sooner. Individuals in the top 10 percent of those with fatalistic attitudes were 79 percent more likely to die than those in the lowest 10 percent, even after researchers adjusted for significant factors such as age, stroke severity and other illnesses.

Similarly, stroke survivors in the top 10 percent for helplessness/hopelessness views (feeling overwhelmed and afraid they are dying) were 58 percent more likely to die than those in the lowest 10 percent for helplessness/hopelessness. However, neither mood, anxiety, depression, nor three other attitude clusters (fighting spirit, denial, anxious preoccupation) were associated with survival.

In the study, a research psychologist visited 372 individuals six months after they'd had a stroke. Each was evaluated for disability, independence in daily activities and given self-rated tests of their depression, anxiety and attitudes toward their strokes. Follow-up was done three to five years after the stroke. Eighty-two patients (22 percent) had died within three years.

The reasons for the correlation with fatalism and helplessness/hopelessness may be related to the progress of recovery a patient had made in six months, according to the authors.

Previous animal tests indicated a link between stress and the hypothalamus gland, which is associated with mood and survival after stroke. Future studies should seek to examine whether any intervention can decrease feelings of fatalism and in turn improve survival rates, researchers say.

S.C. Lewis, Ph.D., senior research fellow, University of Edinburgh, Edinburgh, Scotland; 44-131-537-2932; e-mail: steff.lewis@ed.ac.uk.

Vitamin D crucial to avoiding hip fracture after stroke

DALLAS - Vitamin D deficiency in elderly disabled stroke survivors may contribute to a higher rate of hip fractures, researchers reported in the July issue of Stroke: Journal of the American Heart Association.

Alarmed by a statistic showing that the risk of hip fracture after stroke is two to four times that of a control population of individuals who hadn't had a stroke, and noting that the number of elderly stroke survivors is increasing, Japanese researchers studied the effects of vitamin D levels on hip fracture risk. Vitamin D deficiency leads to softening of the bones due to lack of minerals, most notably calcium. Hip fractures are associated with more deaths, disability, and medical costs than all other osteoporosis-related fractures combined.

Researchers analyzed levels of the substance 25-hydroxyvitamin D (25-OHD) - a byproduct of vitamin D metabolism - and bone mineral density in a group of 236 patients. The participants were age 65 or older and paralyzed on one side for more than one month after a stroke. The patients completed a questionnaire about diet and sunlight exposure, and each one's average vitamin D intake was calculated.

Eighty-eight patients were rated "deficient" because they had 25-OHD levels of 10 nanograms per milliliter (ng/mL) or less. The 76 people with levels of 10 to 20 ng/mL were rated "insufficient" and 72 with levels 21 ng/mL or higher were rated "sufficient." Patients with blood 25-OHD concentrations of 5 ng/mL or less were considered to have severe vitamin D deficiency.

Patients were assessed every two weeks for two years. The number of fractures was 7.1 times higher in the deficient group than the insufficient group. The fractures occurred on the paralyzed side in seven deficient patients and one insufficient patient after a fall. In contrast, no hip fractures occurred in the sufficient group.

Older age (average 74) and severe immobilization were noted in the deficient group. The average age of the insufficient group was 71, while the average age of the sufficient group was 68. In addition, all the deficient patients with fractures were considered severely deficient with 25-OHD levels at or below 5 ng/mL. Researchers conclude the combination of immobility and advanced age may cause 25-OHD deficiency. This in turn leads to reduced bone mineral density, which raises the fracture risk.

Previous research indicated that vitamin D and calcium supplements reduced hip fractures in postmenopausal women. More research is needed to determine whether the incidence of hip fractures in stroke survivors can be reduced with vitamin D or calcium supplements.

Yoshihiro Sato, M.D.; Professor, Institute of Brain Science, Hirosaki University School of Medicine, Japan; fax: 81-172-36-3827; e-mail: noukenrs@cc.hirosaki-u.ac.jp

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CONTACT: For journal copies only, please call: 214-706-1396 For other information, call Carole Bullock: 214-706-1279. Bridgette McNeill: 214-706-1135.

NR01-1308 (Stroke/July Highlights)

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