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Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly)
This article is a CME certified activity. To earn credit for this activity visit: http://www.medscape.org/viewarticle/769518
CME Released: 09/04/2012; Valid for credit through 09/04/2013 Target Audience This article is intended for primary care clinicians, neurologists, pulmonologists, cardiologists, and other specialists who care for patients with reduced lung function. Goal The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Learning Objectives Upon completion of this activity, participants will be able to: 1. Identify major risk factors for low lung function. 2. Describe the association between reduced long function and subarachnoid hemorrhage. Credits Available Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ Family Physicians - maximum of 0.25 AAFP Prescribed credit(s) All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Accreditation Statements
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. This enduring material activity, Medscape Education Clinical Briefs, has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2011. Term of approval is for 1 year from this date. Each Clinical Brief is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of each Clinical Brief. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Note: Total credit is subject to change based on topic selection and article length. Medscape, LLC staff have disclosed that they have no relevant financial relationships.
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University of California. Scudder. Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? CME News Author: Pam Harrison CME Author: Désirée Lie. Pam Harrison has disclosed no relevant financial relationships.7 years. California. California Disclosure: Désirée Lie. Family Medicine.07/09/12 Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly) Pam Harrison is a freelance writer for Medscape. MD. Orange. DC Disclosure: Laurie E. it is not clear if it is associated with an increased risk for SAH. and the risk for SAH among men and women. The contribution of reduced lung function to the development of SAH is comparable with the effects of hypertension and smoking — both known risk factors for SAH. This is a prospective cohort study among participants who had lung function assessed to determine if there is an association between low lung function. was significantly associated with an increased incidence of SAH. has disclosed no relevant financial relationships. female sex. Rossmoor. MSEd CME Released: 09/04/2012. Family Medicine. DNP. and excessive alcohol intake. Editor(s) Laurie E. MD.64 for SAH compared with patients in the highest FEV1 quartile. expressed as both FEV1 and the ratio of FEV1 and FVC (FEV1/FVC). CME Author(s) Désirée Lie. Irvine. www. University of California. NP Nurse Planner. MD. DNP. subarachnoid hemorrhage (SAH) accounts for 1% to 10% of strokes worldwide and is associated with higher mortality risk and earlier onset vs other forms of stroke. patients in the lowest quartile of FEV1 had an unadjusted hazard ratio (HR) of 2. Medscape. Valid for credit through 09/04/2013 According to the current study by Engström and colleagues. George Washington University. NP. Risk factors include older age. hypertension. Irvine. new research shows.org/viewarticle/769518_print 3/7 . Continuing Professional Education Department. Scudder. has disclosed the following relevant financial relationship: Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services CME Reviewer(s) Sarah Fleischman CME Program Manager. LLC Disclosure: Sarah Fleischman has disclosed no relevant financial relationships. MSEd. At a mean follow-up of 25.medscape. LLC. Investigators from Lund University in Sweden found that reduced lung function. Director of Research and Patient Development. Although low lung function has been linked to a risk for all-cause stroke. Clinical Assistant Professor. smoking. as measured by forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FEV1/FVC). School of Nursing and Allied Health. Medical Center. Washington. MSEd Clinical Professor. Medscape. family history.
MD. For this analysis. told Medscape Medical News.000 person-years.3 per 100. share common mechanisms. 97. corresponding to an overall crude incidence of 20. Unlike FEV1 and FEV1/FVC.000 person-years. FEV1. respectively. FVC. which is the major reason for SAH. In women. hazard ratio. Furthermore.org/viewarticle/769518_print 4/7 .3%. Adjusted Hazard Ratios for SAH in Relationship to Quartiles (Q) of FEV1 and FEV1/FVC Q4 (highest) Q3 Q2 Q1 (lowest) P Value for Trend FEV1/HR 1 2. Mean age at SAH was 59 years. corresponding values were 95. subarachnoid hemorrhage.4%. SAH. Between 1974 and 1992.01 1. forced vital capacity.003 FEV1. respectively.8%. "Our hypothesis is that matrix degradation of vessel walls. healthy individuals. In contrast. a total of 20. FVC.000 person-years than in men at 18.07/09/12 Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly) Increased risk for SAH remained significant after established risk factors for SAH were taken into account. Table. also from Lund University in Sweden. at an HR of 2." This study was published online August 7 in Strok e. and 99. 97%. no significant association was noted between SAH and FVC.30 1. both of which are measures of pulmonary obstruction.39 2. Incidence Higher in Women Previous studies had shown that reduced lung function increases the risk for all-cause as well as ischemic stroke. results were consistent when analysis was restricted to nonsmokers. forced expiratory volume in 1 second.58 2.534 men and 7237 women." co-investigator Gunnar Engström. and 98. The incidence of SAH was higher in women at 26.5 per 100.2% of predicted. with a mean age of 44 years at baseline. HR. At baseline. were included. PhD. the risk of SAH was more than doubled in subjects with FEV1 in the lowest quartile as compared with those with FEV1 in the highest quartile. "And results suggest that pulmonary obstruction and not lung volumes are of importance for the risk of SAH. and degradation of lung tissue. which is a major reason for reduced FEV1.7%.medscape. and FEV1/FVC were 95. but whether reduced lung function also increases the risk for SAH had not been previously studied. At follow-up. in men.2 for the lowest vs the highest FEV1 quartiles.014 FEV1/FVC 1 1. Spirometry was performed in complete birth cohorts during most but not all of the screening period. a large-scale screening program — The Malmo Preventive Project — was carried out to detect individuals at high risk for cardiovascular disease. "In the present cohort of middle-aged.92 . Investigators sought to elucidate the relationship between lung function and the incidence of SAH in a large prospective cohort from an urban population.3 per 100.24 . 98 men and 47 women had experienced an SAH. FVC is more related to the volume of the lungs and often is increased in chronic obstructive lung disease compared with reductions in both FEV1 and FEV1/FVC. taking several possible www.
alcohol screening. After exclusion of those with prior stroke. from the University of Miami. and FEV1/FVC were expressed as percentages of predicted values. Published online August 7. told Medscape Medical News that identification of reduced lung volume as a risk factor for SAH is a "novel finding" that has not. Spirometry was performed with a specific apparatus measuring FEV1 and FVC in the standing position without nose clips. Results were independent of systolic blood pressure — another important risk factor for SAH — as well as antihypertensive treatment at baseline. emigration. Sacco has disclosed no relevant financial relationships. 20." he noted. death. whichever came first. identifying any new risk factor for SAH is not easy. and 10th Revision. and mechanism studies would be helpful. angina. and erythrocyte sedimentation rate (ESR). 44 years for women at baseline. Participation rate was 71%. FEV1. in Florida. myocardial infarction." the authors write. physical activity assessment. Strok e. Participants received baseline measurements for blood pressure. including smoking and hypertension. glucose. However. while the second most important way is to measure blood pressure regularly and treat hypertension with antihypertensive drugs. with 10. although further studies are needed to confirm the association. No significant interaction with hypertension was noted. Dr. the association between reduced lung function and SAH identified in the current study may indeed be a true one. codes. When adjusted for smoking.534 men and 7237 women were analyzed for this study.444 men were examined between 1974 and 1984. and missing information." Dr. The risk for SAH was analyzed and expressed as HR by quartiles of FEV1 and FVC.org/viewarticle/769518_print 5/7 . Sacco indicated. Dr. "There have been other studies showing a relationship with reduced lung function with CVD [cardiovascular disease] and ischemic stroke. or occurrence of SAH. Mean age was 43 years for men.902 women examined between 1977 and 1992. the Swedish Research Council. Lundstrom's Foundation. the first preventive measure patients can take to reduce SAH risk is to stop smoking and reduce exposure to environmental smoke." Novel Finding Ralph Sacco. 9th Revision. as Dr. Engström concluded. as Dr. Engström has disclosed that he is employed as a senior epidemiologist by AstraZeneca R&D.medscape. MD. and funds from both Lund University and Sk ane University Hospital. because SAH is much less frequent than other forms of stroke. "[In the meantime]. Sacco also noted that Swedish investigators did control for other important risk factors for SAH. "Low FEV1 is a new risk factor for SAH." they add. www. Patients with SAH were extracted from the stroke register and other patients ascertained from the death register by the International Classification of Diseases. All participants were monitored until the end of 2008. to his knowledge. been reported before. Sacco suggested. 8th Revision. Dr. FVC. "the HR for SAH in subjects with reduced lung function was even higher when the analysis was restricted to nonsmokers. 2012. spirometry. Given this. the Swedish Strok e Foundation. This study was supported by the Swedish Heart and Lung Foundation.07/09/12 Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly) confounders into account. as the authors discuss. which may give new insights into the pathogenesis of SAH and help us to identify individuals at higher risk. body mass index (BMI). and blood tests for cholesterol. Leonard Miller School of Medicine. 22. The Malmo Preventive Project was conducted in Sweden between 1974 and 1992.
higher BMI.96 for FEV1 and 1. higher systolic blood pressure. In nonsmokers. the respective HRs were 1. cholesterol.5 in women and 18.53 for FEV1/FVC. higher systolic blood pressure. physical inactivity. use of antihypertensive medication. reflecting existing findings. Risk factors for low lung function include current smoking. use of antihypertensive medication. independent of other risk factors. higher BMI.000 person-years (26. high cholesterol levels. high cholesterol levels.org/viewarticle/769518_print 6/7 . To receive AMA PRA Category 1 Credit™.42. 98 men and 47 women had SAH for an incidence of 20. Low lung function is associated with an increased risk for SAH among both men and women. the HR was 2.3 per 100. diabetes. physical inactivity. alcohol consumption.64.24 after adjustment for other risk factors (BMI. A 50-year-old smoker with a BMI of 30 kg/m2 and a blood pressure of 120/80 mm Hg would like to reduce his risk for low lung function. the HR was 1. At a mean of 25. the patient described in the first question is in the lowest quartile of FEV1. physical inactivity.medscape.66 for FEV1/FVC after adjustment. Low FEV1 and low FEV1/FVC were associated with an increased risk for SAH. Which of the following best describes his risk for SAH vs someone with an FEV1 in the fourth (highest) quartile? Increased 2-fold Similar Increased only if his blood pressure is also increased Increased 5 times Save and Proceed This article is a CME certified activity. The association was stronger among older participants. and elevated ESR. and ESR). and mean age at SAH was 59 years. The crude HR for SAH for the lowest vs the highest quartile of FEV1 was significant at 2. alcohol consumption.3 in men).47 and 2. In participants with normal blood pressure. In women. The HR remained significant at 2.7 years of follow-up. The authors concluded that low lung function was associated with an increased risk for SAH in both men and women and that the incidence of SAH was higher in women vs men.org/viewarticle/769518 www. Mean time from screening to SAH was 14.52 for FEV1 and 1. Which of the following best describes potential strategies to accomplish this goal? Increase both physical activity and alcohol intake Stop smoking and reduce alcohol intake Reduce BMI and start taking a statin Stop smoking and use an antihypertensive medication At 5 years later.68 for FEV1/FVC.medscape. and elevated ESR. the HR was 1.68 for FEV1 and 1.07/09/12 Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly) Low values of FEV1 and FVC were associated with current smoking. In men. To earn credit for this activity visit: http://www.6 years. you must receive a minimum score of 70% on the post-test.
To earn credit for this activity visit: http://www. A qualified healthcare professional should be consulted before using any therapeutic product discussed.org/viewarticle/769518_print 7/7 .medscape. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products.medscape.07/09/12 Reduced Lung Function and Subarachnoid Hemorrhage: Similar Mechanisms? (printer-friendly) Medscape Education © 2012 Medscape.medscape.org/viewarticle/769518 www. LLC Disclaimer The material presented here does not necessarily reflect the views of Medscape. This article is a CME certified activity.org. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity. LLC. or companies that support educational programming on www.
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