Specific features of free radical processes in comorbid patients with acute stroke and transient ischemic attack

Objective: to study the course of free radical processes (FRP) and the role of glycolytic disorders in patients with stroke and transient ischemic attack (TIA) developing in the presence of several vascular diseases (vascular comorbidity).

Patients and methods. The study enrolled 141 patients aged 28–94 years (mean age 65.48±13.44 years) with stroke and TIA developing in the presence of vascular comorbidity. Ischemic stroke was diagnosed in 87 (61.7%) patients, hemorrhagic stroke and TIA were in 35 (24.8%) and 19 (13.5%) patients, respectively. Their neurological and functional status was evaluated over time using the U.S. National Institute of Health stroke scale, the Barthel index, and the Rankin scale. Plasma FRP was investigated over time from the oxygen and lipid peroxide markers of oxidative stress. After hospital discharge, the patients were followed up for 6 months to 6 years. Survival and recurrent cardiovascular event rates were estimated.

Results. In the patients with prior stroke, the severity of vascular comorbidity correlated with the rise in death rates that within 6 years after hospital discharge were 42.9% and 8.3% in patients with 4 cardiovascular diseases (CVD) and 1 CVD, respectively. Vascular comorbidity correlated with the outcome of the disease. Emphasis was laid on the role of hyperglycemia in the breakdown of adaptive processes in stroke. The low level of malonic dialdehyde and the high antiperoxide activity of secondary plasma in the stroke patients are markers for good in-hospital functional recovery and reduced poststroke mortality rates during a long-term follow-up.

Conclusion. Stroke and TIA develop in the presence of obvious vascular comorbidity that predetermines the severity of the disease. The FRP values correlating with dysenergetic processes are significant prognostic markers in both acute and chronic stroke.

1. Гусев ЕИ, Скворцова ЛВ, Стаховская ЛВ. Проблема инсульта в Российской Федерации: время активных совместных действий. Журнал неврологии и психиатрии им. С.С. Корсакова. 2007;107(8):1–11. [Gusev EI, Skvortsova VI, Stakhovskaya LV. Stroke in the Russian Federation: time for united concentrated activites. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2007;107(8):1–10. (In Russ.)]

2. Howard VJ. Reasons underlying racial differences in stroke incidence and mortality. Stroke. 2013;44(6 Suppl 1):S126–8. DOI:10.1161/STROKEAHA.111.000691.

3. Nagata K, Suzuki K. Update on stroke epidemiology. Brain Nerve. 2013;65(7):857–70.

4. Парфенов ВА, Вербицкая СВ. Ведение больного, перенесшего ишемический инсульт. Клиническая геронтология. 2012;18(11–12):3–10. [Parfenov VA, Verbitskaya SV. Management of patients with ischemic stroke. Klinicheskaya gerontologiya. 2012;18(11–12):3–10. (In Russ.)]

5. Румянцева СА, Ступин ВА, Афанасьев ВВ и др. Второй шанс (современные представления об энергокоррекции). Москва: МИГ «Медицинская книга», 2010. 176 с. [Rumyantseva SA, Stupin VA, Afanas'ev VV, et al. Vtoroi shans (sovremennye predstavleniya ob energokorrektsii) [Second chance (modern ideas of power correction)]. Moscow: MIG «Meditsinskaya kniga», 2010. 176 p.]

6. Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 288 p.]

7. Sarraj A, Albright K, Barreto AD, et al. Оptimizing prediction scores for poor outcome after

8. intra-arterial therapy in anterior circulation acute ischemic stroke. Stroke. 2013;(44):3324–30. DOI:

9. http://dx.doi.org/10.1161/STROKEAHA.113.001050.

10. Орлова АС, Меньшова НИ, Румянцева СА и др. Сердечно-сосудистая коморбидность и дисбаланс свободнорадикальных процессов у больных с острым нарушением мозгового кровообращения. Казанский медицинский журнал. 2013;94(6):813–7. [Orlova AS, Men'shova NI, Rumyantseva SA, et al.

11. Cardiovascular comorbidity and free radical mediated processes imbalance in patients with acute stroke. Kazanskii meditsinskii zhurnal. 2013;94(6):813–7. (In Russ.)]

12. Manzanero S, Santro T, Arumugam TV. Neuronal oxidative stress in acute ischemic stroke: sources and contribution to cell injury. Neurochem Int. 2013. 62(5):712–8. DOI: http://dx.doi.org/10.1016/j.neuint.2012.11.009.

13. Верткин АЛ, Румянцев МА, Скотников АС. Коморбидность. Клиническая медицина. 2012;90(10):4–11. [Vertkin AL, Rumyantsev MA, Skotnikov AS. Comorbidity. Klinicheskaya meditsina. 2012;90(10):4–11. (In Russ.)]

14. Юсупова ШК. О нарушении функционального состояния симпатико-адреналовой системы и процессов перекисного окисления липидов при сахарном диабете 2 типа с артериальной гипертонией у мужчин. Российский кардиологический журнал. 2009;(2):27–30. [Yusupova ShK. Sympathoadrenal system dysfunction and lipid peroxidation in men with type 2 diabetes mellitus and

15. arterial hypertension. Rossiiskii kardiologicheskii zhurnal. 2009;(2):27–30. (In Russ).]

16. Elnakish MT, Hassanain HH, Janssen PM. Emerging role of oxidative stress in metabolic syndrome and cardiovascular diseases: important role of Rac/NADPH oxidase. J Pathol. 2013 Nov;231(3):290–300.

17. Румянцева СА, Силина ЕВ, Орлова АС и др. Гипергликемия и свободнорадикальный дисбаланс как прогностические маркеры острого нарушения мозгового кровообращения. Анналы клинической и экспериментальной неврологии. 2012;6(4):26–9. [Rumyantseva SA, Silina EV, Orlova AS, et al. Hyperglycemia and free radical imbalance as prognostic factors in acute stroke. Annaly

18. klinicheskoi i eksperimental'noi nevrologii. 2012;6(4):26–9. (In Russ.)] 14. Ding D, Qiu J, Li X Hyperglycemia and mortality among patients with coronary artery disease. Diabetes Care. 2014 Feb;37(2):546–54. DOI: http://dx.doi.org/10.2337/dc13-1387.

19. Lipton JA, Barendse RJ, Van Domburg RT. Hyperglycemia at admission and during hospital

20. stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive

21. cardiac care unit. Eur Heart J Acute Cardiovasc Care. 2013 Dec;2(4):306–13. DOI: http://dx.doi.org/10.1177/2048872613489304