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Stroke

Drugs to ‘re-programme’ white blood cells could prevent strokes

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Medication which targets white blood cells and stabilises atherosclerotic plaques could be used to help prevent strokes, new research has revealed. 

By ‘re-programming’ white blood cells, the ability to switch them from a pro-inflammatory to an anti-inflammatory state has been discovered. Pro-inflammatory white blood cells are known to make atherosclerotic plaques unstable, making them more likely to rupture and block blood flow to the brain.

When the University of Sheffield research team took a type of white blood cell known as macrophages from human blood samples and treated them with a common anti-inflammatory drug for 24 hours, they found that the macrophages themselves became anti-inflammatory.

Unveiling their findings yesterday at the British Cardiovascular Society conference, the anti-inflammatory macrophages were also less able to bind to and ingest harmful oxidised LDL (OxLDL), known to play a major role in atherosclerosis and present in high quantities in plaques most likely to lead to a stroke.

Each year in the UK more than 100,000 people have a stroke, with around a quarter of these caused by a build-up of atherosclerotic plaques in the carotid arteries – the main blood vessels in the neck.

Currently, the only way to prevent unstable plaques from disintegrating and causing a stroke is to remove them in surgery. The researchers hope that in the future anti-inflammatory drugs could be used to stabilise plaques and reduce the risk of a stroke occurring without the need for surgical intervention. 

Professor Sheila Francis, Professor of Cardiovascular Biology at the University of Sheffield, says: “We’ve found an entirely new way to stabilise the most threatening atherosclerotic plaques and we’re really excited about the potential to use this method to prevent strokes.

“We now need to see whether anti-inflammatory drugs have the same effect within the body itself and, if so, we’ll be looking to take them swiftly into clinical trials.”

“In the UK, 1.3 million people are living with the after-effects of stroke. For many of them there is no proven treatment to limit the damage the stoke has caused. Preventing a stroke before it strikes is the ultimate ambition in stroke medicine,” says Professor James Leiper, associate medical director at the British Heart Foundation. 

“This research is at an early stage now but if these findings can be replicated and extended in people we may finally have found a way to reduce risk of the risk of stroke for many thousands of people each year.”

News

Risk calculator ‘will save many lives from stroke or heart attack’

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A new risk calculator will better predict people at high risk of stroke or heart attack years before they strike and is ready for use across the UK and Europe, it has been announced. 

The risk calculator, SCORE2, will be adopted by the upcoming European Guidelines on Cardiovascular Disease Prevention in Clinical Practice, and enables doctors across Europe in the next ten years with greater accuracy than ever before.

The research team behind the breakthrough say this new prediction tool will help save many more people across Europe from having a potentially deadly heart attack or stroke, ultimately saving lives. 

People who are flagged as having an increased risk can be put on personalised preventative treatment, such a statins, or will receive lifestyle advice to lower their risk.

“This risk tool is much more powerful and superior than what doctors have used for decades. It will fit seamlessly into current prevention programmes with substantial real-world impact by improving the prevention of cardiovascular diseases across Europe before they strike,” says Professor Emanuele Di Angelantonio at the University of Cambridge British Heart Foundation (BHF) Centre of Research Excellence.

Around 200 investigators from across Europe were involved in the development of SCORE2, with data analysed from nearly 700,000 participants – mostly middle-aged – from 45 different studies. The tool has also been tailored for use in different European countries.

Participants had no prior history of heart and circulatory disease when they were recruited to the studies, and in the ten years they were followed up, 30,000 had a ‘cardiovascular event’ – including fatal or non-fatal heart attack or stroke.

The risk tool was then statistically ‘recalibrated’, by using regional-specific cardiovascular and risk factor data from 10.8 million people, to more accurately estimate cardiovascular risk for populations split into four European risk regions. 

The tool uses known risk factors for heart and circulatory diseases such as age, sex, cholesterol levels, blood pressure and smoking.

This is a much-needed upgrade from the previous prediction tool that was developed using data before 1986 and underestimated the cardiovascular risk in some countries. The new SCORE2 risk calculator now accounts for current trends in heart and circulatory diseases, can predict both fatal and non-fatal conditions and is adaptable to countries with different levels of risk.

The researchers say that this upgrade will better estimate the cardiovascular risk amongst younger people, and will improve how treatment is tailored for older people and those in high-risk regions across Europe.

Dr Lisa Pennells, from Cambridge’s BHF Centre of Research Excellence, says: “This project was a highly collaborative effort that has brought together key experts and extensive data sources to develop improved risk prediction tools for cardiovascular disease for use across the UK and Europe.

“A key feature is that our calculators are relevant to current day rates of cardiovascular disease in different regions of Europe. Importantly, our methods allow them to be easily updated using routinely collected data in the future to ensure they stay relevant as trends in heart and circulatory diseases change.”

This study was carried out by the SCORE2 Working Group and the European Society of Cardiology Cardiovascular Risk Collaboration. It was supported by organisations including the British Heart Foundation, the Medical Research Council, National Institute for Health Research Cambridge Biomedical Research Centre and Health Data Research UK.

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Patient story

Getting back into sport after a stroke from head injury

Keen sportsman and fundraiser Graeme Cadas had a stroke after a head collision playing football, but efforts from his friend mean he can now continue his charity work

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Graeme Cadas enjoying a kick about

Greame Cadas from Hartlepool has had a passion for sport his entire life.

The 49-year-old has often put this love to good use as well, completing a number of fundraisers for a range of charities.

He raised £5,000 for the Denise Taylor cancer trust and Bradley Lowery by running up Ben Nevis twice in two days and also completed the Great Manchester Cycle.

One sport he particularly loves is football he had been playing for and helping run his local team Hartlepool TECH for a number of years.

However he could never have foreseen that this passion would lead him to one day have a stroke.

On Easter weekend in 2017, Graeme was playing for his beloved TECH when he collided heads with an opposition player.

He thought nothing of it as he claims he felt fine afterwards but it wasn’t until two days later that the effects of this would fully reveal themselves.

After enjoying a takeaway and a night in on the Sunday, he woke up on the Monday to make himself a cup of tea and go back to bed.

Not long afterwards his son Jack, who was 15 at the time, found him on the floor suffering a stroke and immediately called an ambulance.

Graeme says his memory is very blurred after this, with the next thing he can remember being waking up in hospital.

Doctors would later reveal that this was due to that innocuous head collision he suffered, much to his surprise.

“I didn’t even know I was having a stroke at the time,” Graeme said. “It was a complete shock when the doctor said it had come about from heading that person, I couldn’t believe it.

“The biggest shock was that I thought a stroke was just an old person’s injury or illness.”

From this Graeme had to undergo months of rehabilitation where he relearned to walk and talk but he had nothing but praise for the staff that helped him

“I was very lucky as to when it happened,” he said. “It was pre-COVID and the NHS staff and nurses were amazing.

“I had physios coming three times a week to my house. I lost about a year but they helped me do my own rehab which I still do to this day.”

Because the stroke occurred in the left side of his brain he can no longer fully use his right side but admits he is extremely lucky he didn’t lose his speech permanently.

For many this would stop them ever attempting sport again, but Graeme’s friend Mario did not want to let his enthusiasm go to waste.

He has now set up a fundraiser to get Graeme a specially designed left-handed trike that he can use to get out and resume exercising.

The device will cost around £4,000 with Graeme overwhelmed by the support he has received so far.

“It’s been amazing,” he said. “People have been so generous it’s unbelievable, I can’t wait to get on it.”

As well as getting him active again Graeme is looking forward to using the trike to continue his fundraising efforts

This charity work is something that stays in the Cadas family, with his wife Amanda completing the Stroke Association’s Resolution Run alongside Jack in 2018 for the cause.

One thing his stroke has not stopped him doing is getting involved with Hartlepool TECH, which he now helps manage after stepping back from the pitch.

It only took Graeme three months to get back involved with the team and he said he was ‘delighted’ to jump at the chance of helping out again.

The club are now returning this favour with a race night to try and raise the last £500 he needs to purchase the trike.

Graeme constantly thanked those who helped him while speaking to NR Times, but admitted the person he owes the most to is his son who’s actions saved his life on that day four years ago.

To donate to his fundraiser and find out more, click here.

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Stroke

Strokes ‘more severe in COVID patients’

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People with COVID-19 have more severe strokes, with the potential to strike at a younger age, new research has found. 

The COVID-19 Stroke Study Group’s latest report shows that nearly 45 per cent of strokes among people with the virus are large vessel occlusion (LVO) – in the general population, this is between 24 to 28 per cent. 

It also found that more than a third of people in the group were younger than 55, and nearly half were younger than 65. Pre-pandemic general population data showed 13 per cent of strokes occurred in people under 55, and 21 per cent in people younger than 65.

The report focused on a group of 432 patients from 17 countries diagnosed with COVID-19 and stroke.

The data also showed that that less severe strokes, mostly in critically ill patients or overwhelmed health centres, were under-diagnosed. This finding is significant, the research team say, as minor or less severe stroke may be an important risk factor for a more severe stroke in the future.

“Our observation of a higher median stroke severity in countries with lower healthcare spending may reflect a lower capacity for the diagnosis of mild stroke in patients during the pandemic, but this may also indicate that patients with mild stroke symptoms refused to present to the hospitals,” said Ramin Zand, a vascular neurologist and clinician-scientist at Geisinger and leader of the study group.

Throughout the pandemic, people with COVID-19 have reported symptoms involving the nervous system, ranging from a loss of smell or taste to more severe and life-threatening conditions such as altered mental state, meningitis and stroke. 

A group of Geisinger scientists and a team of experts from around the world formed the COVID-19 Stroke Study Group shortly after the pandemic began to study the correlation between COVID-19 infection and stroke risk.

Results from the first phase of the study, which included data on 26,175 patients, indicated an overall stroke risk of 0.5 per cent to 1.2 per cent among hospitalised patients with COVID-19 infection. 

The finding demonstrated that, even though there were increasing reports of patients with COVID-19 experiencing stroke, the overall risk is low.

“Our initial data showed that the overall incidence of stroke was low among patients with COVID-19, and while that hasn’t changed, this new data shows that there are certain groups of patients – for example, younger patients – who are more affected,” says Vida Abedi, a scientist in the department of molecular and functional genomics at Geisinger. 

“We hope these findings highlight new research directions to better identify patients at risk and help improve the quality of care.”

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