The American Heart Association has published a new scientific statement in the journal Stroke. This statement provides expert analysis of current research on the topic of cognitive impairment after stroke. The statement advises healthcare professionals to screen stroke survivors for cognitive impairment and provide comprehensive interdisciplinary care to support those affected. This guidance may be used to inform future guidelines on the topic.

Dr. Nada El Husseini, who led the writing committee for the scientific statement, said that cognitive impairment is a condition that stroke survivors often face but is not reported or diagnosed enough. She emphasized the importance of systematically evaluating stroke survivors for cognitive impairment to begin treatment as soon as possible when symptoms appear.

The American Heart Association’s 2023 Statistical Update states that around 9.4 million adults in America have had a stroke, which makes up about 3.6% of the adult population. Cognitive impairment may occur shortly after a stroke or even years later.

Nada El Husseini, M.D., M.H.Sc., FAHA, stated that cognitive impairment after stroke can vary from minor impairment to dementia and can impact many aspects of life such as memory, language, planning, attention, and a person’s ability to work, drive, or live independently.

The scientific statement talks about problems with thinking and memory after a stroke. There are two main types of strokes: one is caused by a blockage in a blood vessel going to the brain and the other happens when a blood vessel in the brain bursts. The first type of stroke is more common, while the second type is less common.

According to the statement:

• Many stroke survivors experience cognitive impairment within the first year after their stroke, with up to 60% of survivors affected. This impairment is most likely to occur within the first two weeks after a stroke.
• After a stroke, almost 40% of people experience cognitive impairment during the first year that doesn’t meet the criteria for dementia, but it still affects their quality of life.
• It’s possible for up to 20% of stroke survivors who experience mild cognitive impairment to fully recover their cognitive function. The best chance for recovery is within the first 6 months after a stroke.
• After a stroke, cognitive impairment is often linked to other conditions, such as physical disabilities, sleep disorders, changes in behavior and personality, depression, and other neuropsychological changes. These factors can all negatively impact a person’s quality of life.

Diagnosing and managing cognitive impairment after stroke

The scientific statement mentions that there is no universally accepted method for testing cognitive function after a stroke. However, there are some brief screening tests that can be used to identify cognitive impairment after a stroke. Two commonly used tests are the Mini-Mental State Examination and the Montreal Cognitive Assessment, which can both be completed in 30 minutes or less.

Detecting cognitive changes over time is important to help stroke survivors manage their condition better. Early detection of cognitive impairment is crucial for planning immediate care. If someone is having difficulty with activities related to memory, following instructions, or providing medical history, it might be an indication of cognitive impairment. Additional cognitive screening is necessary for those people. Neuropsychological screenings are recommended to evaluate brain function and to identify the cognitive strengths and weaknesses of individuals. It helps healthcare professionals provide better care to patients.

According to the scientific statement, healthcare professionals should provide guidance to stroke survivors and their caregivers regarding topics such as home safety, returning to work, and driving after a stroke. They should also connect stroke survivors and caregivers to community resources to provide social support.

To provide the best care for stroke survivors with cognitive impairment, different healthcare professionals such as physicians, occupational therapists, speech language therapists, neuropsychologists and nurses need to work together. They need to monitor the patient and offer care as needed. Cognitive rehabilitation and physical activity are also suggested to improve cognition after a stroke.

To prevent cognitive impairment from getting worse after a stroke, it’s important to prevent another stroke from occurring. This can be done by treating risk factors for stroke such as high blood pressure, high cholesterol, type 2 diabetes, and atrial fibrillation. Keeping blood pressure under control can lower the risk of having another stroke and also reduce the risk of mild cognitive impairment.

Future research needs

The scientific statement acknowledges that there are still unknowns about how cognitive impairment develops after a stroke, and how non-brain factors like infection, frailty, and social factors play a role. More research is needed to better understand cognitive screening after a stroke and to develop screening tools that take into account factors like age, culture, and language.

Dr. El Husseini highlights the urgent need for developing effective and culturally appropriate treatments for post-stroke cognitive impairment. Large clinical trials are necessary to assess the effectiveness of different techniques, medications, and lifestyle changes in improving cognitive function for diverse groups of patients.

This scientific statement was created by a group of volunteers representing different branches of the American Heart Association. The purpose of the statement is to increase awareness and knowledge about stroke and cognitive impairment. The statement provides information on what is currently known about the topic and what areas need further research. It is important to note that while the statement can inform healthcare decisions, it does not make specific treatment recommendations. The American Heart Association’s guidelines are used to provide official clinical practice recommendations.

Co-authors are Vice-Chair Irene L. Katzan, M.D., M.S., FAHA; Natalia S. Rost, M.D., M.P.H., FAHA; Margaret Lehman Blake, Ph.D., C.C.C.-S.L.P.; Eeeseung Byun, R.N., Ph.D.; Sarah T. Pendlebury, F.R.C.P., D.Phil.; Hugo J. Aparicio, M.D., M.P.H.; María J. Marquine, Ph.D.; Rebecca F. Gottesman, M.D., Ph.D., FAHA; and Eric E. Smith, M.D., M.P.H., FAHA. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

“The results are promising because for the first time a medicine studied as a neuroprotectant demonstrated not only a biological benefit by reducing the volume of damaged brain tissue, but also a reduction in long term disability and risk of death,” said study senior author Marc Ribó, M.D., an interventional neurologist at Hospital Vall d’Hebron in Barcelona, Spain.

In this clinical trial, researchers investigated if the neuroprotective medication ApTOLL may improve outcomes among people with stroke who also received standard treatment. ApTOLL is a TOLL-like receptor 4 (TLR4) antagonist involved in immune responses, yet it also responds to tissue damage. Previous studies in animals found that ApTOLL reduced inflammation and protected brain tissue from damage. Also, a first-in-human study in healthy adults did not find safety issues with ApTOLL.

From July 2021 to April 2022, more than 150 adults diagnosed with stroke (average age 70 years) treated in 15 hospitals in France and Spain were randomly assigned to either 0.05mg/kg of ApTOLL, 0.2mg/kg of ApTOLL or a placebo.

Within six hours of symptom onset, all participants also received the standard ischemic stroke treatment to restore blood flow to the brain — mechanical blood clot removal. This treatment, also called endovascular therapy, involves insertion of a tiny tube into the blood vessel to retrieve the blood clot. Study participants also may have received the clot-busting medication known as tPA if needed to help dissolve the clot.

Among the trial’s findings:

The higher ApTOLL dose showed a neuroprotective effect while the lower dose did not show any effect compared to placebo.

Ninety days after treatment, death rates among participants who received the higher dose of ApTOLL were more than four times lower compared to those who received placebo: 4% versus 18%, respectively.

Imaging tests given 72 hours after treatment showed that the size of damaged brain tissue was reduced by 40% among the participants who received the higher dose of ApTOLL compared to the placebo group.

64% of participants who received the higher dose of ApTOLL were free of disability at 90 days, compared to 47% of those in the placebo group.

“If the results are confirmed with larger studies, it will mean that we can effectively treat patients with neuroprotectants, in addition to current standard treatments to restore blood flow,” said co-lead author Macarena Hernández, Ph.D. “Both kinds of treatments may be combined, and neuroprotectants will buy time, reducing brain damage until blood flow is restored.”

A study limitation is its small number of participants. Larger studies are in the planning stages, according to Ribó.

The fifth-leading cause of death in the United States and a major cause of long-term disability, stroke caused more than 160,000 U.S. deaths in 2020, according to the 2023 American Heart Association statistics.

The new research, published in the peer-reviewed journal Stroke, is the first U.S.-wide study to find that patients who had more severe strokes received higher amounts of rehabilitation therapy, a welcome finding. “But in the bigger picture, the findings reinforce that too many patients are missing out on a golden opportunity to maximize recovery during a critical period following a stroke,” said the study’s lead author, Steven Cramer, MD. Stroke is a leading cause of long-term disability in the United States and can affect speech, memory, and mobility, among other impairments.

“In the initial weeks after a stroke, the brain is ready to undergo maximum rewiring to get people back on their feet. Rehab therapy helps maximize this recovery, with higher rehab therapy doses helping more, but what we found in this study is that most patients are getting rather small doses of rehab therapy,” said Dr. Cramer, a stroke neurologist and professor of neurology at the David Geffen School of Medicine at UCLA and the California Rehabilitation Institute.

Among the study’s key findings:

–Many patients tracked in this study did not receive any rehabilitation therapy after their stroke. After three months, about one-third of patients had not received physical therapy, almost half had not received occupational therapy, and over 6 in 10 did not receive speech therapy.

–Those who did receive rehabilitation therapy typically had six to eight sessions by three months after their stroke – and between 0 and 1.5 sessions the rest of the year.

–Where patients were sent following hospitalization also mattered. Those who were discharged home had the lowest levels of rehabilitation therapy, regardless of the severity of their stroke.

–Hispanic patients received disproportionately lower amounts of physical therapy and occupational therapy.

Cramer said it is important for future research to examine the feasibility of providing higher therapy doses to stroke patients.

The other study authors are Brittany Young, MD, PhD, of UCLA and the California Rehabilitation Institute, and Alison Holman, PhD, FNP, of the Sue and Bill Gross School of Nursing at UC-Irvine.

Fatty deposits (plaque) can accumulate in arteries causing them to narrow (stenosis). Narrowed arteries in the carotid artery (in the neck) can cause an ischemic stroke, which occurs when a vessel that supplies blood to the brain is obstructed by a clot. Nearly 87% of all strokes are ischemic strokes.

“Between 2% and 5% of strokes each year occur in people with no symptoms, so better and earlier detection of stroke risk is needed,” said lead study author Hsien-Li Kao, M.D., an interventional cardiologist at National Taiwan University Hospital in Taipei, Taiwan.

“This was an exciting ‘eureka’ moment for us,” Kao said in a news release from the American Heart Association. “Existing diagnostic methods – ultrasound, CT and MRI – require screening with specialized medical imaging equipment and personnel. Analysis of video recorded on a smartphone is non-invasive and easy to perform, so it may provide an opportunity to increase screening. Though more research and development are needed, the recordings and motion analysis may be able to be implemented remotely, or a downloadable app may even be feasible.”

Arteries in the neck are just beneath the skin’s surface and changes in the velocity and pattern of blood flow through them are reflected in the motion of the overlying skin, Kao explained. However, these differences are too subtle to be detected by the naked eye.

According to the AHA news release, this study, conducted between 2016 and 2019, used motion magnification and pixel analysis to detect the minute changes in pulse characteristics on the skin’s surface captured in a smartphone video recording.

A group of 202 Taiwanese adults (average age of 68 years; roughly 79% men) who received care at a single Taiwanese hospital participated in the study. Among the participants, 54% had significant carotid artery stenosis, meaning they had at least 50% blockage that was previously diagnosed by ultrasound, while 46% did not have significant stenosis. Recordings were captured with participants laying on their back, with their head tilted back in a custom-made box that minimized outside movement. An Apple iPhone 6, 64GB, was mounted to the box to capture a 30-second video recording of the person’s neck. The older generation phone was used as researchers believed it would be more common to the average user, Kao said.

Researchers found that the video motion analysis algorithm had an 87% accuracy rate of detecting stenosis in the group known to have carotid artery stenosis. All study participants also had standard Doppler ultrasound testing to confirm narrowing in their arteries and to gauge and validate the estimates from the video motion analysis.

“More research is needed to determine whether video recorded on smartphones is a promising approach to help expedite and increase stroke screening,” Kao said. “Carotid artery stenosis is silent until a stroke happens. With this method, clinicians may be able to record a video of the patient’s neck with a smartphone, upload the videos for analysis and receive a report within five minutes. The early detection of carotid artery stenosis may improve patient outcomes.”

“The motivation for this study was the National Cancer Institute (NCI)’s Moonshot initiative that includes smoking cessation among people with cancer. We were curious to understand smoking among people with stroke and cardiovascular disease,” said Neal Parikh, M.D., M.S., lead author of the study and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center in New York City. “In part to assess whether a similar program is necessary for stroke survivors, our team compared smoking cessation rates between stroke survivors and cancer survivors.”

The investigators analyzed data collected between 2013 and 2019 from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, a national health survey that collects information regarding chronic health conditions and health-related behaviors annually.

Researchers analyzed data from 74,400 respondents who reported having a prior stroke and a history of smoking (median age of 68 years; 45% women; 70% non-Hispanic white), and 155,693 respondents who identified as cancer survivors with a history of smoking (median age of 69 years; 56% women; 81% non-Hispanic white). Previous smoker status was defined as having smoked at least 100 cigarettes in their lifetime.

After adjusting for demographic factors and the presence of smoking-related medical conditions, researchers found that:

Stroke survivors were found to be 28% less likely to have quit smoking compared to people with cancer.

61% of stroke survivors reported that they had quit smoking.

Stroke survivors under the age of 60 were far less likely to have quit smoking (43%) compared to stroke survivors ages 60 and older (75%).

“If you told a stroke neurologist that 40% of their patients don’t have their blood pressure controlled or weren’t taking their aspirin or their cholesterol-lowering medication, I think they would be very disappointed,” said Parikh, who is also an assistant professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine. “These results indicate that we should be disappointed – more of our stroke patients need to quit smoking. We can and should be doing a lot better in helping patients with smoking cessation after stroke.”

The researchers also found that stroke survivors who live in the Stroke Belt – eight states in the southeastern United States with elevated stroke rates (North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana) – were around 6% less likely to have quit smoking than stroke survivors in other areas of the U.S. Increasing smoking cessation is one factor than can be addressed to reduce the disproportionately high rates of strokes and stroke deaths in the Stroke Belt.

“Important next steps are devising and testing optimal smoking cessation programs for people who have had a stroke or mini-stroke,” said Parikh. “Programs for patients with stroke and cardiovascular disease should be as robust as smoking cessation programs offered to patients with cancer. At NCI-designated sites, smoking cessation programs often include a dedicated, intensive counseling program, a trained tobacco cessation specialist, and health care professionals with specific knowledge about the use of smoking cessation medications. Hospital systems could also adjust care protocols so that every stroke patient receives a consultation with a tobacco cessation specialist and is enrolled in a smoking cessation program with the option to opt out, as opposed to having to seek out a program.”

A limitation of the study is that the data in the survey was self-reported – it relied on individuals to indicate if they have ever smoked or are currently smoking. The study population is also limited because it included only people who live independently in the community, rather than those living in a nursing home or other living facility.

And they don’t stop because of a pandemic. About one in four people worldwide have a stroke — the world’s No. 2 killer and a leading cause of disability. But up to 80% may be prevented.

That’s why the American Stroke Association (ASA), a division of the American Heart Association (AHA), is commemorating World Stroke Day on Oct. 29, this Thursday, by emphasizing the importance of preventing stroke. Much of what puts you at risk for a stroke (uncontrolled high blood pressure, smoking or obesity) increases your risk for complications due to COVID-19.

The association’s World Stroke Day efforts will include a focus on controlling high blood pressure, because it’s the leading preventable cause of stroke: “Checking your blood pressure regularly and getting it to a healthy range is one of the most important things you can do to reduce your risk of stroke,” said Mitchell S. V. Elkind, M.D., M.S., FAHA, FAAN, president of the AHA and professor of neurology and epidemiology at Columbia University in New York City.

These tips can help keep your blood pressure in a healthy range (120/80) — and lower your stroke risk:

Join the team. Work with your doctor and other health care professionals to manage your blood pressure through lifestyle changes and/or medication.

Take medications as prescribed. If you have been prescribed blood pressure medications, take them as prescribed.  Check the labels on over the counter cold or flu medications, as some may elevate your blood pressure.  If you have high blood pressure, NSAIDs may cause elevated blood pressure. Consider acetaminophen instead.

Eat colorful fruits and veggies. A heart-healthy diet may help lower blood pressure over time.

Rest up. Getting seven to nine hours of quality sleep each night can improve brain function. Sleep-related breathing issues may increase stroke risk, so seek treatment right away if you suspect sleep apnea or a similar problem.

Meditate. Practicing mindfulness and being aware of your breathing may significantly reduce blood pressure.

Be active. Adults should get at least 150 minutes per week of moderate activity or 75 minutes of vigorous activity (or a combination). Two days per week of moderate- to high-intensity muscle strengthening activity is also recommended.

Still, experts say, reducing stroke risk isn’t always just a matter of changing daily habits.

“Structural racism and other forms of discrimination make it more difficult for Black, Latinx, Indigenous, LGBT and other marginalized people to access the tools they need to fully control their risk factors for stroke,” Elkind said.

There is growing evidence that historically marginalized groups in the U.S. live with increased stress and reduced access to health care, socioeconomic and psychological factors. As a result, up to 40% of Black adults in the U.S. have high blood pressure and Black people who have a stroke are more than twice as likely to die from it than white people.

“At the American Stroke Association and American Heart Association, we’re working with individuals, organizations, businesses and government to address the root causes of these inequities to ensure longer, healthier lives for all. It will take all of us, coming together to make change at individual and structural levels.”

Know the most common warning signs

In addition to managing your own risks, Elkind and the ASA advise all people to be ready to save a life by remembering the most common stroke warning signs using the acronym FAST – F for face drooping, A for arm weakness, S for speech difficulty and T for time to call 911.

“Getting emergency medical treatment for a stroke is safe, even during the pandemic,” Elkind said. “Calling 911 helps treatment start even before you reach the hospital, improving chances for a better recovery.”

For more information on how to get involved in antii-stroke efforts, click here to visit the ASA website.

Hyperglycemia, or high levels of glucose, is common in patients with acute ischemic stroke and is associated with worse outcomes compared to normal blood sugar levels. Animal studies also pointed to an effect of high blood sugar in worsening stroke injury. Stroke experts have debated whether intensive glucose management after acute ischemic stroke leads to better outcomes, but a new study in JAMA finds that aggressive methods are not better than standard approaches.

The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“After decades of uncertainty about how to manage blood sugar in acute stroke patients we finally have strong clinical evidence that aggressive lowering does not improve patient outcome,” said Walter Koroshetz, M.D., NINDS director.

The Stroke Hyperglycemia Insulin Network Effort (SHINE) study, a large, multisite clinical study led by Karen C. Johnston, M.D., professor of neurology and Associate Vice President of Clinical & Translational Research at the University of Virginia, Charlottesville, compared two commonly used strategies for glucose control in ischemic stroke patients. More than 1100 patients underwent intensive glucose management, which required the use of intravenous delivery of insulin to bring blood sugar levels down to 80-130 mg/dL, or standard glucose control using insulin shots, which aimed to get glucose below 180 mg/dL, for up to 72 hours. After 90 days, the patients were evaluated for outcomes, including disability, neurological function, and quality of life.

The results suggested that the two treatments were equally effective at helping the patients recover from their strokes. After 90 days, about 20% of the patients showed favorable outcomes regardless of whether they were given intensive or standard treatment.

Intense glucose therapy increased the risk of very low blood glucose (hypoglycemia) and required a higher level of care such as increased supervision from nursing staff, compared to standard treatment.

The study was stopped early when a pre-planned interim analysis revealed that intensive glucose control did not improve outcomes compared to standard treatment.

“We found that the extra risks associated with aggressive treatment were not worth it,” said Johnston. “We are so grateful to the patients and research teams from across the country who helped us answer this important question. As a result of their participation, patients around the world will benefit.”

More research is needed to better understand the role of glucose in stroke recovery and to identify additional treatments to improve outcomes in hyperglycemic stroke patients. Future studies will also determine whether high blood sugar is a cause or effect of unfavorable stroke outcomes.

For more information on similar studies, click here.

The discovery was published in the American Heart Association’s journal Hypertension.

People who have had a stroke caused by a blood clot (ischemic strokes) often need to take oral medications that make their blood less likely to clot, which helps prevent another stroke.

The vaccine worked as well as the oral blood thinner clopidogrel.

Japanese researchers successfully tested an experimental vaccine in mice and found that it provided protection against blood clots for more than two months without increasing the risk of bleeding or causing an autoimmune response. The lack of an autoimmune response is important, because it means the animal’s immune system did not perceive the vaccine as an “intruder” that needed to be attacked.

The vaccine, S100A9, also worked as well as the oral blood thinner clopidogrel in a major artery, according to Hironori Nakagami, M.D., Ph.D., study co-author and professor at Osaka University, in Japan.

Developing a vaccine to replace and/or complement dailyoral medications might save many lives and help prevent both secondary strokes and possibly heart attacks, according to Nakagami. “Many stroke patients don’t take their blood thinning drugs as prescribed, which makes it more likely they will have another stroke,” he said. “This vaccine might one day help solve this issue since it would only need to be injected periodically.

Consider these statistics from the American Stroke Association:

• Stroke is the fourth-leading cause of death for U.S. women and kills twice as many of us as breast cancer.
• Each year, about 55,000 more women have strokes than men, and because we tend to live longer, strokes have a greater impact on our total quality of life.
• High blood pressure is the most well-known risk factor for stroke. Nearly one third of Hispanic women and almost 50 percent of African American women have this condition, putting them at increased risk.

A handy shorthand for the most common warning signs of a stroke is: F.A.S.T.: If you experience (F) face drooping, (A) arm weakness, or (S) speech difficulty, it’s (T) time to call 911.

Sadly, when it comes to stroke, time is of the essence as two million brain cells die every second one goes untreated during a stroke emergency. For this reason, it’s critical that women of all ages, but particularly those forty and older, be on the lookout for F.A.S.T. and for subtle signs of stroke. These include:

1. Sudden numbness or weakness of the face, arms or legs, especially on one side of the body: Losing feeling or strength on one side of your body is a common sign of stroke, especially in your limbs. Your face may also droop and lose strength. Those experiencing this symptom – to any degree – should seek immediate medical attention.
2. Sudden confusion, trouble speaking or understanding: Slurred speech, difficulty speaking, or trouble understanding others are also key indicators. Some patients don’t recognize this symptom until it’s pointed out to them. If someone says you sound different, take this seriously, particularly if it’s accompanied by the experience of another symptom on this list.
3. Sudden loss of sight or blurred vision in one or both eyes: You might lose sight or have blurred vision in one or both eyes if you’re having a stroke. Specifically, it’s common to lose the same field of vision in both eyes. For example, you might be unable to look to the right in both of your eyes.
4. Sudden trouble walking, dizziness, loss of balance or coordination: You may become dizzy, lose your balance or faint during or after a stroke. For some patients, this symptom starts slowly, and they are reluctant to believe it could be attributed to experiencing a stroke. It is important to remember that these symptoms are not normal and do require immediate medical attention.
5. Sudden severe headache with no known cause: Headaches are one of the sneakiest symptoms of stroke because they can have a myriad of other causes. That said, headaches that are severe and sudden are common symptoms of hemorrhagic strokes, which while less common than ischemic strokes, are more dangerous.

If you or someone you know is suffering from any of these symptoms, call 911 immediately. Even if the symptoms are minor and/or last only a few minutes, they could indicate a transient ischemic attack or “mini stroke,” which may signal a more severe stroke ahead and should be taken just as seriously. Remember: No stroke is minor, and time is brain. The sooner the treatment, the better the recovery.

Women who have had a stroke are at increased risk of having another one. Aspirin is commonly used to help prevent second clot-related strokes, but it’s important to talk to a doctor before starting an aspirin regimen.

While it is imperative to know the signs of stroke and what to do when one occurs, there is good news: Up to 80 percent of first and second strokes may be preventable. By managing a healthy life style and taking doctor-directed medication to maintain risk factors like high blood pressure, you may be able to stop it before it starts.

For more about Dr. Bauman’s work, click on her byline (above).

A prospective study examined data on more than 300,000 Danish schoolchildren – born between 1930-1989 who were examined at ages 7, 10 and 13. Researchers noted that boys and girls who were 2 to 3 inches shorter than average for their age were at increased risk of clot-related (ischemic) stroke in adult men and women and of bleeding stroke in men.

While adult height is genetically determined, it is also influenced by factors such as maternal diet during pregnancy, childhood diet, infection and psychological stress. Several of these factors are modifiable and all are thought to affect the risk of stroke.

Researchers noted that a decline in stroke incidence and mortality rates in most high-income countries, primarily in women, occurred simultaneously with a general increase in attained adult height. Taken together, this suggests the involvement of shared underlying mechanisms for height and stroke development.

According to a news release from the AHA, researchers say these results have implications for understanding disease origin rather than for clinical risk prediction,and future studies should focus on the mechanisms underlying the relationship between childhood height and later stroke.

“Our study suggests that short height in children is a possible marker of stroke risk and suggests these children should pay extra attention to changing or treating modifiable risk factors for stroke throughout life to reduce the chances of having this disease,” said senior study author Jennifer L. Baker, Ph.D., associate professor in the Center for Clinical Research and Prevention at Bispebjerg and Frederiksberg Hospital and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, at the University of Copenhagen, in Denmark.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke – the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit www.heart.org or call any of our offices around the country.