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Among people who suffer a stroke, one in 12 are likely to have another stroke soon after the initial attack and one in four will die within a year, according to a new study by researchers from the Medical University of South Carolina.

The state-wide statistics highlight the importance of recognizing that anyone who has had a stroke is at a high risk for having another one and also has an increased likelihood of having other problems, such as a heart attack, experts say

“Our findings suggest that South Carolina and possibly other parts of the United States may have a long way to go in terms of preventing and reducing the risk factors for recurrent strokes,” said Dr. Wuwei Feng, a neurology resident at the university and the study’s lead researcher.

For the study, published in the Feb. 16 issue of Neurology, Feng’s team collected data on almost 10,400 people in South Carolina who’d had a stroke.

They found that 25 percent of those who had a stroke died within a year, and eight percent had another stroke within a year of their first stroke.

After one year, the risk for another stroke or death continued to rise, the researchers found, with about 18 percent having had another stroke within four years. In that time, about six percent had a heart attack and 41 percent had died from any cause, including 27 percent whose deaths were attributed to a stroke or heart attack.

The risks were higher among blacks than among whites, the study noted. The risks also increased with age and the number of other medical problems that people had.

“Stroke is a devastating disease,” Feng said. “Once you have it, you are at a high risk to have another one, as well as heart attack or death.”

Dr. Majaz Moonis, director of stroke services at the University of Massachusetts, said that “this is one more study that essentially points to what many others have already.”

Moonis believes the key to preventing second strokes is aggressive care and follow-up. “It is important to continue to point out the health-care disparities and the need for more aggressive care,” he said.

“In our stroke prevention clinic — where we regularly follow patients with ischemic stroke on a six-month basis with imaging, labs and vascular studies and treat them with very aggressive measures for stroke prevention — the annual rate of recurrent stroke is 1.5 percent, far lower than the community,” Moonis said.

Another stroke expert, Dr. Larry B. Goldstein, director of the Duke University Stroke Center, noted that his own study of stroke patients throughout the United States showed that the highest rate for recurrent stroke was in the Southeast, which has been called the “stroke belt.”

Of course, having a first stroke puts you at a 10-fold increased risk of having another, he said, and “in the country overall, about 20 percent of strokes are recurrent strokes.”

Goldstein also said that, in many cases, not enough effort is directed at preventing a second stroke. Using blood thinners, for example, can reduce the risk for a second stroke by about 48 percent, he said.

“Adequate treatment of high blood pressure reduces the risk by about 40 percent,” Goldstein said. “The use of antiplatelet drugs reduces the risk by about 16 to 20 percent. The use of a statin reduces the risk by about 16 percent.”

In addition, lifestyle changes such as a following a healthier diet, exercising more and quitting smoking will also reduce the risk of a second stroke, he said.

“There are a ton of things we try to do to reduce the risk of recurrent stroke,” Goldstein said.

SOURCES: Wuwei Feng, M.D., resident in neurology, department of neuroscience, Medical University of South Carolina, Charleston, S.C.; Larry B. Goldstein, M.D., professor and director, Duke Stroke Center, Duke University, Durham, N.C.; Majaz Moonis, M.D., director, stroke services, University of Massachusetts Medical School, Worcester, Mass.

Harvard researchers report what they say is a major advance toward the long-sought goal of a genetic test that can distinguish between aggressive prostate cancers that require urgent treatment and slow-growing tumors that can safely be left alone.

Today, many men diagnosed with prostate cancer are treated with radiation or chemotherapy even though most of those cancers will grow so slowly that they are not dangerous. It is the cancers that metastasize — spread outside the prostate gland — that typically are life-threatening.

“For the first time, we showed in a mouse model that when you take a gene out, you get metastasis and when you put it back in you don’t get metastasis,” said study author Karen Cichowski, an assistant professor of medicine in the division of genetics at Harvard’s Brigham and Women’s Hospital. “It looks like the entire pathway is driven by this one gene, the cascade that drives metastasis.”

Studies of human prostate cancers have shown the same effect, she said: “We have looked at the genetic pathway in a large number of human tumors, and have found it to be deregulated in more advanced prostate cancers.”

The finding could lead to better treatment of prostate cancer, because the molecule whose production is governed by the gene can be a target of drug therapy, Cichowski said.

The molecule, designated EZH2, is an enzyme, and “enzymes are always good potential therapeutic targets,” she said. “Many companies are working to develop EZH2 inhibitors.”

The Brigham and Women’s program is one of a number being carried out in competitive fashion at several U.S. medical research centers. They are looking at a cluster of genes whose connection with prostate cancer was first described in 2002 by Jer-Tsong Hsieh, a professor of pathology and urology at the University of Texas Southwestern Medical Center at Dallas.

“We complement each other; our findings are very similar,” Hsieh said of the Harvard work. “I am a cell biologist and look for the protein. She uses a genetic approach.”

Hsieh’s group has published several papers on the research, one as recent as last month. One current effort is to develop a chemical reagent that can detect the enzyme, he said.

Another researcher in prostate cancer genetics is Dr. Arul Chinnaiyan, a professor of pathology and urology at the University of Michigan.

The newly reported study “provides a nice mechanistic link as to why EZH2 leads to metastatic cancer,” Chinnaiyan said. “It is exciting because there is a lot of interest in the biotechnology world in developing inhibitors of EZH2.”

His laboratory is working on such inhibitors, Chinnaiyan added.

“Chinnaiyan showed that this gene for EZH2 is highly expressed in advanced prostate cancer,” Cichowski said. “Hsieh showed that a second gene in this genetic pathway was a target of EZH2 and could be silenced by EZH2. It was one of 250 genes targeted by EZH2. We showed that in a mouse model the gene is the primary target of EZH2 in prostate cancer.”

That gene, DAB2IP, is suppressed in human prostate cancer, and the degree of suppression correlates with the aggressiveness of a cancer, the journal report said.

“This is the first study to definitively show not only the gene but also the pathway that drives metastasis in prostate cancer,” Cichowski said. “Now that we know this pathway, there are many ways to target it.”

SOURCES: Karen Cichowski, Ph.D., assistant professor, medicine, division of genetics, Brigham and Women’s Hospital, Boston; Jer-Tsong Hsieh, Ph.D., professor, urology, University of Texas Southwestern Medical Center, Dallas; Arul Chinnaiyan, M.D., Ph.D., professor, pathology and urology, University of Michigan, Ann Arbor

The use of cholesterol-lowering statin drugs increases the chance of developing diabetes by 9 percent, but the absolute risk is low, especially when compared with how much statins reduce the threat of heart disease and heart attack, new research shows.

The researchers analyzed data from 13 clinical trials of statins conducted between 1994 and 2009. The trials included a total of 91,140 people. Of those, 2,226 participants taking statins and 2,052 people in control groups developed diabetes over an average of four years.

Overall, statin therapy was associated with a 9 percent increased risk of developing diabetes, but the risk was higher in older patients. Neither body mass index nor changes in LDL (bad) cholesterol levels appeared to affect the statin-associated risk of developing diabetes.

There’s no evidence that statin therapy raises diabetes risk through a direct molecular mechanism, but this may be a possibility, said study authors Naveed Satar and David Preiss, of the University of Glasgow’s Cardiovascular Research Center, and colleagues.

The researchers noted that slightly improved survival among patients taking statins doesn’t explain the increased risk of developing diabetes. They added that while it’s highly unlikely, the increased risk of diabetes among people taking statins could be a chance finding.

To put their findings in context, the study authors pointed out that if 255 patients took statins for four years, there would be only one extra case of diabetes. However, for each millimole per liter reduction in LDL cholesterol achieved by taking statins, the same 255 patients would experience five fewer major coronary events, such as coronary heart disease death or non-fatal heart attack.

“In view of the overwhelming benefit of statins for reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by cardiovascular benefit in the short and medium term in individuals for whom statin therapy is recommended,” the researchers wrote in a news release.

“We therefore suggest that clinical practice for statin therapy does not need to change for patients with moderate or high cardiovascular risk or existing cardiovascular disease. However, the potentially raised diabetes risk should be taken into account if statin therapy is considered for patients at low cardiovascular risk or patient groups in which cardiovascular benefit has not been proven,” they concluded.

The study authors also recommended monitoring of older people taking statins, since they have a higher risk of developing diabetes.

The findings were published online Feb. 16 and will appear in an upcoming print issue of The Lancet.

The benefit of taking statins to reduce cardiovascular risk greatly outweighs the risk of developing diabetes by a ratio of about 9:1, Dr. Christopher P. Cannon, of the cardiovascular division at Brigham and Women’s Hospital and Harvard Medical School in Boston, wrote in an accompanying comment article.

“Nonetheless, this newly identified risk does warrant monitoring, and as such, in addition to periodic monitoring of liver-function tests and creatine kinase, it seems reasonable to add glucose to the list of tests to monitor in older patients on statins,” Cannon said.

SOURCE: The Lancet