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Chagas disease: independent risk factor for stroke
Leonardo C Paixão1, Antonio L Ribeiro, Reginaldo A Valacio
1Odilon Behrens Hospital, Federal University of Minas Gerais Faculdade de Medicina, Belo Horizonte, Brazil. leonardopaixao@yahoo.com.br
Insights
Chagas disease (CD) is an independent risk factor for ischemic stroke. This study suggests considering CD in patients from endemic areas presenting with stroke symptoms.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Chagas disease (CD) cardiomyopathy is a suspected risk factor for cerebrovascular events.
- Evidence linking CD to stroke is limited, with proposed cardioembolic and inflammatory mechanisms.
- Previous studies often lacked adequate control groups for comparison.
Purpose of the Study:
- To determine if Chagas disease (CD) is an independent risk factor for ischemic stroke.
- To compare stroke patients with acute coronary syndrome patients with similar cardiovascular risk profiles.
- To investigate the association between CD serology and stroke incidence.
Main Methods:
- A case-control study involving 101 ischemic stroke patients and 100 acute coronary syndrome patients.
- Chagas disease (CD) diagnosis confirmed by positive immunofluorescence and hemagglutination tests.
- Analysis of clinical, laboratory, and electrocardiogram (ECG) findings.
Main Results:
- CD-positive serology was significantly more frequent in stroke patients (P=0.002).
- Independent predictors of stroke included prior stroke/TIA (OR=6.98), atrial fibrillation (OR=4.52), and CD-positive serology (OR=7.17).
- Age, female sex, and blood pressure were also associated with stroke in univariate analysis.
Conclusions:
- Chagas disease (CD) appears to be an independent risk factor for ischemic stroke.
- CD should be considered a potential etiological factor in stroke patients from endemic regions.
- Further research may elucidate specific mechanisms linking CD to cerebrovascular events.
Background And Purpose:
It has been suggested that Chagas disease (CD) and particularly CD cardiomyopathy are independent risk factors for cerebrovascular events. Strong evidence is scarce, cardioembolic and inflammatory mechanisms have been proposed, and most studies lack representative and well-matched controls. We sought to investigate CD, defined by positive serology, as an independent risk factor for stroke, by comparing patients admitted with ischemic stroke with representative control patients with a very similar cardiovascular risk factor profile.
Methods:
We performed a case-control study with 101 consecutive stroke patients and 100 consecutive acute coronary syndrome patients admitted to an emergency hospital. CD was investigated in all patients and was confirmed when both immunofluorescence and hemagglutination tests were positive. Clinical, laboratory, and ECG findings were analyzed.
Results:
We found that age (P=0.006), female sex (P=0.01), systolic blood pressure (P=0.001), diastolic blood pressure (P=0.03), previous stroke/transient ischemic attack history (P<0.001), atrial fibrillation (P=0.005), other arrhythmias (P=0.05), and CD-positive serology (P=0.002) were more frequent among stroke patients than among patients with acute coronary syndromes. After a multivariable analysis with a backward elimination procedure, previous stroke/transient ischemic attack history (odds ratio=6.98; 95% CI, 2.99 to 16.29), atrial fibrillation (odds ratio=4.52; 95% CI, 1.45 to 14.04), and CD-positive serology (odds ratio=7.17; 95% CI, 1.50 to 34.19) remained independently associated with stroke.
Conclusions:
CD seems to be an independent risk factor for ischemic stroke. For patients in or coming from endemic regions, CD should be considered an etiologic or contributing factor for stroke.
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