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Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis

Journal of Human Hypertension volume 38, pages 676–686 (2024)Cite this article

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Abstract

Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I2 = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.

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Fig. 1
Fig. 2: Weighted mean and standard deviation of PWV.
Fig. 3: Forest plots of meta-analysis for clinical outcomes.

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Authors and Affiliations

  1. Second Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece

    Nikolaos Kakaletsis

  2. First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece

    Nikolaos Kakaletsis & Christos Savopoulos

  3. Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece

    Athanase D. Protogerou

  4. Third Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece

    Vasilios Kotsis

  5. Department of Clinical Therapeutics of Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Konstantinos Vemmos & Eleni Korompoki

  6. Third Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece

    Anastasios Kollias

  7. Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece

    Haralampos Milionis

  8. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

    George Ntaios

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Contributions

All authors significantly contributed to the manuscript and approved the final version for publication. NK, AP, VK, and CS designed the study. NK, AP, VK contributed to data acquisition and performed the statistical analysis. NK, AP, KV, EK, AK, HM, and GN contributed to the interpretation of data. NK wrote the first manuscript draft. All authors edited the final manuscript draft. NK is the guarantor of this work.

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Correspondence to Nikolaos Kakaletsis.

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Kakaletsis, N., Protogerou, A.D., Kotsis, V. et al. Advanced vascular aging and outcomes after acute ischemic stroke: a systematic review and meta-analysis. J Hum Hypertens 38, 676–686 (2024). https://doi.org/10.1038/s41371-024-00961-y

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