title: Overlap of diseases underlying ischemic stroke: the ASCOD phenotyping.
abstract: OBJECTIVE
  ASCOD phenotyping (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; and D, dissection) assigns a degree of likelihood to every potential cause (1 for potentially causal, 2 for causality is uncertain, 3 for unlikely causal but disease is present, 0 for absence of disease, and 9 for insufficient workup to rule out the disease) commonly encountered in ischemic stroke. We used ASCOD to investigate the overlap of underlying vascular diseases and their prognostic implication.
  
  
  METHODS
  A single rater applied ASCOD in 405 patients enrolled in the Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study.
  
  
  RESULTS
  A was present in 90% of patients (A1=43% and A2=15%), C in 52% (C1=23% and C2=14%), and S in 66% (S1=11% and S2=2%). On the basis of grades 1 and 2, 25% of patients had multiple underlying diseases, and 80% when all 3 grades were considered. The main overlap was found between A and C; among C1 patients, A was present in 92% of cases (A1=28%, A2=20%, and A3=44%). Conversely, among A1 patients, C was present in 47% of cases (C1=15%, C2=15%, and C3=17%). Grades for C were associated with gradual increase in the 3-year risk of vascular events, whereas risks were similar across A grades, meaning that the mere presence of atherosclerotic disease qualifies for high risk, regardless the degree of likelihood for A.
  
  
  CONCLUSIONS
  ASCOD phenotyping shows that the large overlap among the 3 main diseases, and the high prevalence of any form of atherosclerotic disease, reinforces the need to systematically control atherosclerotic risk factors in all ischemic strokes.
authors.affiliation: Paris-Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Gaia
authors.initials: G
authors.lastname: Sirimarco
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallée
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Céline
authors.initials: C
authors.lastname: Guidoux
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Valérie
authors.initials: V
authors.lastname: Adraï
authors.forename: Jérôme
authors.initials: J
authors.lastname: Kusmierek
authors.forename: Samina
authors.initials: S
authors.lastname: Ratani
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D002545:Brain Ischemia / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012306:Risk; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*
keywords: atherosclerosis; etiology; stroke