Home Medizin Welche Faktoren beeinflussen das Wiederauftreten eines Schlaganfalls nach einer Chagas-Krankheit?

Welche Faktoren beeinflussen das Wiederauftreten eines Schlaganfalls nach einer Chagas-Krankheit?

von NFI Redaktion

Following the largest historical cohort study ever conducted in Brazil, which suggested a link between Chagas disease and ischemic stroke, researchers from Fluminense Federal University have described the profile of patients at risk for stroke recurrence due to the combination of these two conditions. Cardiovascular risk, age, and gender influence the recurrence of stroke in patients with a history of stroke and Chagas disease, as detailed in an article published in Cerebrovascular Diseases.

Understanding the epidemiological background of patients with Chagas disease who have suffered a stroke contributed to a more targeted case monitoring and allowed for the most appropriate treatment for patients at higher risk of stroke recurrence. Data from the 2022 Epidemiological Bulletin published by the Brazilian Ministry of Health indicate that there are between 1.9 and 4.6 million people with Chagas disease in Brazil. An average of 4,000 deaths per year from the disease were registered over a 10-year period.

According to the authors of the article, „there is still a noticeable lack of comprehensive epidemiological studies examining the link between Chagas disease and ischemic stroke.” Given the impact that both diseases have on public health, researchers conducted a survey to address a critical research gap. The work originated from the doctoral thesis of neurologist Vinicius Montanaro, MD, PhD, from the SARAH Network of Rehabilitation Hospitals in Brasília, Brazil. Montanaro collaborated with colleagues from study centers across Brazil to access and analyze patient records and examinations.

The study centers involved in the research were Albert Einstein Hospital, the University of São Paulo, Federal University of Bahia, Risoleta Tolentino Neves Hospital, Federal University of Minas Gerais, Federal University of Pernambuco, and SARAH Rehabilitation Hospital. These facilities were located in urban and rural areas. The idea was to obtain a representative sample of the social and demographic diversity of the Brazilian population and cases of Chagas disease.

Researchers conducted a retrospective analysis of medical records and examinations of 499 patients over 18 years old who were observed in these centers from January 2009 to December 2016. The study considered patients whose Chagas disease was confirmed by two serological tests and stroke by CT or MRI. Demographic factors such as gender, age, and cardiovascular risk were evaluated.

The group found that cardiovascular risk factors predominated in patients with Chagas disease. Approximately 81% of participants had hypertension, 56% had dyslipidemia, and 25% had diabetes. The stroke recurrence rate in the individuals studied was 29.7%. Overall, 56% of patients experienced a cardioembolic stroke of undetermined cause. Another finding was that women had an 83% higher risk of experiencing a stroke recurrence.

Researchers speculated that hormonal factors and the use of contraceptives could explain the increased risk in women.

Given the socioeconomic characteristics and limited access to health resources of this population, some variables were not available in all centers, according to the authors.

„Patients with Chagas disease come from socially disadvantaged areas, which makes follow-up care difficult,“ said Montanaro.

The study suggested that controlling risk factors and comorbidities helped prevent strokes in patients with Chagas disease.

„Now we know which patients to pay more attention to in order to have a more appropriate etiological investigation for diagnosing cardioembolic etiology and also to perform a more precise secondary prophylaxis to avoid stroke recurrence, which leads to a worse functional outcome and a higher mortality rate,“ explained Montanaro.

The research indicated a high recurrence rate of strokes in patients diagnosed with cardioembolism. One possible explanation is the frequency of embolic strokes of undetermined origin in the sample. This prevalence results from an incomplete etiological investigation, the researchers emphasized. Another observation was that age acted as a protective factor: younger patients had fewer heart lesions. The use of anticoagulants also helped reduce the risk of a recurrent stroke. This finding raised questions about the best indication for prophylactic treatment in patients with Chagas disease and a history of ischemic stroke.

A new study aimed at analyzing epidemiological issues to evaluate the most appropriate secondary prophylaxis depending on the diagnosis, whether cardioembolic or undefined, is already underway, Montanaro said. The goal is to determine the best strategy for reducing the risk of stroke.

„This story was translated from the Portuguese edition of Medscape. Several editorial tools, including AI, were used in the process. Human editors reviewed this content before publication.“

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