Publications by authors named "Graeme Hankey"

Objective: Sociodemographic, lifestyle, and medical variables influence total testosterone (T) and sex hormone-binding globulin (SHBG) concentrations. The relationship between these factors and "free" T remains unclear. We examined 21 sociodemographic, lifestyle, and medical predictors influencing calculated free T (cFT) in community-dwelling men across ages.

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Background: There are few proven treatments for acute spontaneous intracerebral haemorrhage, and they all target reducing expansion of the haematoma. The traditional Chinese medicine FYTF-919 (Zhongfeng Xingnao) in an oral solution is comprised of several Chinese herbs that are widely used to treat patients with intracerebral haemorrhage in China on the understanding that they enhance resorption of the haematoma and reduce neuroinflammation. We aimed to provide a reliable assessment of the safety and efficacy of FYTF-919 in patients with moderate to severe acute intracerebral haemorrhage.

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Background And Objectives: Acute stroke is associated with a spectrum of functional deficits. The objective of this analysis was to explore whether the importance of individual risk factors differ by stroke severity, which may be of relevance to public health strategies to reduce disability.

Methods: INTERSTROKE is an international case-control study of risk factors of first acute stroke (recruitment 2007-August 2015) in 32 countries.

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Background And Purpose: Cold beverage intake (carbonated drinks, fruit juice/drinks, and water) may be important population-level exposures relevant to stroke risk and prevention. We sought to explore the association between intake of these beverages and stroke.

Methods: INTERSTROKE is an international matched case-control study of first stroke.

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Article Synopsis
  • The study investigated the link between 25-hydroxy vitamin D (25(OH)D) levels and the risk and progression of abdominal aortic aneurysm (AAA).
  • Researchers recruited 4,673 participants, finding that higher 25(OH)D levels were associated with a reduced likelihood of being diagnosed with AAA, with a significant decrease in odds noted in both Queensland and Western Australia.
  • However, among participants with small AAA, those with higher vitamin D levels experienced faster AAA growth, suggesting a paradox where high vitamin D is linked to both lower diagnosis rates and quicker aneurysm expansion, warranting further investigation.
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  • Direct oral anticoagulants are commonly used for preventing strokes in patients with atrial fibrillation and flutter, but concerns about bleeding limit their use; milvexian is a new drug that might work as well with less bleeding risk.
  • The LIBREXIA AF trial is a large global study comparing milvexian to apixaban, enrolling 15,500 participants to assess if milvexian can prevent strokes without increasing bleeding events significantly.
  • The results from this study aim to clarify the efficacy and safety of milvexian compared to apixaban over a projected 4-year follow-up period.
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Introduction: The traditional Chinese medicine (TCM) herbal compound FYTF-919 (Zhong Feng Xing Nao prescription) may improve outcome from acute intracerebral hemorrhage (ICH) by reducing brain edema, hematoma absorption, and enhancement of the immune system. We outline the statistical analysis plan (SAP) for the Chinese Herbal medicine in Acute INtracerebral haemorrhage (CHAIN) study.

Design: CHAIN is a multicenter, prospective, randomized, double-blind, placebo-controlled trial being undertaken at 20-30 hospitals in China.

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Objectives: To assess the efficacy and safety of colchicine versus placebo on reducing the risk of subsequent stroke after high risk non-cardioembolic ischaemic stroke or transient ischaemic attack within the first three months of symptom onset (CHANCE-3).

Design: Multicentre, double blind, randomised, placebo controlled trial.

Setting: 244 hospitals in China between 11 August 2022 and 13 April 2023.

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Background: Stroke is a leading global cause of death and disability. Daily tea/coffee intake is consumed by > 50% of populations and may represent an important population-level exposure. Therefore, it is first essential that we better understand the associations between the tea/coffee intake and stroke.

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Background: Periodontal disease may be an important modifiable risk factor for stroke.

Aims: To determine the contribution of markers of periodontal disease to stroke risk globally, within subpopulations, and by stroke subtypes.

Methods: INTERSTROKE is the largest international case-control study of risk factors for first acute stroke.

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Article Synopsis
  • DAOH (Days Alive Out of Hospital) is a key end point for assessing patient outcomes in atrial fibrillation treatments, but its clinical utility has not been previously explored in trials.
  • The ROCKET AF trial compared the effectiveness of rivaroxaban and warfarin in patients with atrial fibrillation, revealing similar DAOH outcomes for both treatments, indicating no significant benefit of one over the other.
  • Overall, low event rates among participants led to a skewed distribution in DAOH measurements, which may explain the lack of treatment differences observed in the study.
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Background: Whether circulating sex hormones modulate mortality and cardiovascular disease (CVD) risk in aging men is controversial.

Purpose: To clarify associations of sex hormones with these outcomes.

Data Sources: Systematic literature review to July 2019, with bridge searches to March 2024.

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  • The study examines the link between blood pressure variability during the initial stages of acute stroke and patients' functional outcomes after one month, aiming to identify factors that could modify this variability.
  • Data from 13,206 participants revealed that higher systolic and diastolic blood pressure variability is significantly associated with poorer functional outcomes, particularly when measured by standard deviation (SD).
  • Factors such as age, female sex, high body mass index, and certain lifestyle habits contribute to increased blood pressure variability, indicating that managing these factors could improve outcomes for stroke patients.
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Background And Purpose: Whilst sleep disturbances are associated with stroke, their association with stroke severity is less certain. In the INTERSTROKE study, the association of pre-morbid sleep disturbance with stroke severity and functional outcome following stroke was evaluated.

Methods: INTERSTROKE is an international case-control study of first acute stroke.

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Background: Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking.

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Background: Three large randomized controlled trials of fluoxetine for stroke recovery have been performed. We performed an individual patient data meta-analysis (IPDM) on the combined data.

Methods: Fixed effects meta-analyses were performed on the combined data set, for the primary outcome (modified Rankin scale (mRS) at 6 months), and secondary outcomes common to the individual trials.

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Cerebral amyloid angiopathy (CAA) is a type of cerebrovascular disorder characterised by the accumulation of amyloid within the leptomeninges and small/medium-sized cerebral blood vessels. Typically, cerebral haemorrhages are one of the first clinical manifestations of CAA, posing a considerable challenge to the timely diagnosis of CAA as the bleedings only occur during the later disease stages. Fluid biomarkers may change prior to imaging biomarkers, and therefore, they could be the future of CAA diagnosis.

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Background: The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level.

Aims: We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level.

Methods: In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries.

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Background: People with factor XI deficiency have lower rates of ischaemic stroke than the general population and infrequent spontaneous bleeding, suggesting that factor XI has a more important role in thrombosis than in haemostasis. Milvexian, an oral small-molecule inhibitor of activated factor XI, added to standard antiplatelet therapy, might reduce the risk of non-cardioembolic ischaemic stroke without increasing the risk of bleeding. We aimed to estimate the dose-response of milvexian for recurrent ischaemic cerebral events and major bleeding in patients with recent ischaemic stroke or transient ischaemic attack (TIA).

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Objective: Prevalence of subclinical thyroid disease increases with age, but optimal detection and surveillance strategies remain unclear particularly for older men. We aimed to assess thyroid stimulating hormone (TSH) and free thyroxine (FT4) concentrations and their longitudinal changes, to determine the prevalence and incidence of subclinical thyroid dysfunction in older men.

Design, Participants And Measurements: Longitudinal study of 994 community-dwelling men aged ≥70 years without known or current thyroid disease, with TSH and FT4 concentrations assessed at baseline and follow-up (after 8.

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Background And Purpose: Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain.

Methods: In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023.

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Background: Pre-treatment rebleeding following aneurysmal subarachnoid hemorrhage (aSAH) increases the risk of death and a poor neurological outcome. Current guidelines recommend aneurysm treatment "as early as feasible after presentation, preferably within 24 h of onset" to mitigate this risk, a practice termed ultra-early treatment. However, ongoing debate regarding whether ultra-early treatment is independently associated with reduced re-bleeding risk, together with the recognition that re-bleeding occurs even in centres practicing ultra-early treatment due to the presence of other risk-factors has resulted in a renewed need for patient-specific re-bleed risk prediction.

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Background: Reference intervals of thyroid-stimulating hormone (TSH) and free thyroxine (FT) are statistically defined by the 2·5-97·5th percentiles, without accounting for potential risk of clinical outcomes. We aimed to define the optimal healthy ranges of TSH and FT based on the risk of cardiovascular disease and mortality.

Methods: This systematic review and individual participant data (IPD) meta-analysis identified eligible prospective cohorts through the Thyroid Studies Collaboration, supplemented with a systematic search via Embase, MEDLINE (Ovid), Web of science, the Cochrane Central Register of Controlled Trials, and Google Scholar from Jan 1, 2011, to Feb 12, 2017 with an updated search to Oct 13, 2022 (cohorts found in the second search were not included in the IPD).

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Background: Air pollution is a cause of lung cancer and is associated with bladder cancer. However, the relationship between air pollution and these cancers in regions of low pollution is unclear. We investigated associations between fine particulate matter (PM), nitrogen dioxide, and black carbon (BC), and both these cancers in a low-pollution city.

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