MedWire News: Chagas disease (CD), a protozoan infection prevalent in South America, is an independent risk factor for stroke, Brazilian researchers believe.
Writing in the journal Stroke, the study authors say that infection with CD (also known as American trypanosomiasis) should be considered “an etiologic or contributing factor” in patients from disease-endemic regions.
CD is an established cause of cardiomyopathy and is known to be associated with both cardioembolic and cerebrovascular events. However, it is unclear from current evidence whether CD is independently associated with stroke or simply a marker for other cardiovascular risk factors.
To investigate, Leonardo Carvalho da Paixão (Federal University of Minas Gerais, Belo Horizonte) and colleagues performed a case–control study in which they compared the frequency of CD in 101 consecutive patients with acute stroke (cases) and 100 consecutive patients with acute coronary syndromes (ACS; controls), admitted to the same hospital over a 7-month period.
Acute stroke and ACS are two acute conditions with very similar, well-known cardiovascular risk factors, the authors remark.
The comparison revealed that stroke patients differed significantly from ACS patients in a number of ways; for instance, stroke patients were older, more likely to be women, and had a higher rate of previous stroke, transient ischemic attack (TIA), atrial fibrillation (AF), and hypertension.
Importantly, CD was detected by serology in 14 stroke patients versus just two ACS patients, a highly significant difference. Multivariate analysis confirmed that CD, along with prior stroke/TIA and AF, were each independently associated with stroke, with odds ratios of 7.17, 6.98, and 4.52, respectively.
Carvalho da Paixão and co-authors note that up to 18 million people in South America are thought to be infected with CD. Although most will not develop the full clinical manifestations of CD, some, especially those infected in childhood, may be at increased risk for stroke in later years.
“The association between stroke and CD may be explained by mechanisms involving inflammation and endothelial or endocardial lesions, with consequent thrombogenic disturbances,” they write.
“Thus, for patients in or coming from endemic regions, CD should be considered an etiologic or contributing factor for stroke.”
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