A cohort study on the relationship between cerebrovascular hemodynamic changing and risk of stroke / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the role of cerebrovascular hemodynamic indexes (CVHI) changing in stroke and to provide reference for stroke prevention and risk factor study.</p><p><b>METHODS</b>From 2003 to 2004, participants aged 40 years and above in two communities in Fengxian district were recruited by cluster sampling. Risk factors of stroke and CVHI were investigated and checked during baseline investigation. A total of 10 565 individuals completed the survey and met the inclusion criterion. After baseline investigation, the cohort was followed up for stroke occurrence. Relative risk (RR) of CVHI and common risk factors were estimated by cohort study design.</p><p><b>RESULTS</b>Age of the cohort was (56.2 ± 11.4) years. 4444 (42.1%) were males and 6121 (57.9%) were females. Total follow-up duration was 67 885.7 person-years. A total of 195 stroke cases occurred and incidence density of stroke was 287.2 per 100 000 person-years. Stroke incidence in exposure groups of hypertension, heart disease and alcohol drinking was 3.47% (108/3118), 2.96% (21/710) and 2.50% (47/1882), respectively. The incidence in corresponding non-exposure group was 1.17% (87/7448), 1.77% (174/9855) and 1.70% (148/8683) respectively. There was significant difference between 2 groups (χ(2) value was 62.72, 4.56 and 4.94, respectively, P < 0.05). Stroke incidence in CVHI score < 25, 25 - 49, 50 - 74 and ≥ 75 groups was 9.12% (59/647), 5.68% (44/775), 2.52% (39/1545) and 0.72% (53/7403)(χ(2)trend = 273.57, P < 0.05), respectively. Incidence of stroke in 40 - 49, 50 - 59, 60 - 69, ≥ 70 years age group was 0.22% (8/3565), 1.28% (43/3357), 2.71% (50/1848) and 5.88% (94/1600) (χ(2)trend = 181.48, P < 0.05), respectively. Multiple Cox regression analysis indicated that RR (95%CI) value of hypertension and cigarette smoking was 1.40(1.02 - 1.92) and 1.59(1.19 - 2.12), respectively when comparing with non-exposure group. RR (95%CI) value in CVHI score < 25, 25 - 49 and 50 - 74 points group were 6.15 (4.08 - 9.26), 4.55 (2.98 - 6.96) and 2.68 (1.75 - 4.09), respectively when comparing with the score ≥ 75 points group. RR (95%CI) value in age 50 - 59, 60 - 69 and ≥ 70 years group was 4.61 (2.16 - 9.82), 7.81 (3.67 - 16.60) and 13.49(6.44 - 28.24), respectively when comparing with below 40 years group.</p><p><b>CONCLUSION</b>CVHI score is the strong independent predictive factor and hypertension, cigarette smoking and age are the independent risk factors of stroke.</p>

Study on over-weight, obesity and the exposure to stroke risk factors among 40 year olds and over in a community-based population / 中华流行病学杂志

Objective To describe the distribution of over weight and obesity to discover the level of exposure on risk factors of stroke among people aged 40 and over, in a community-based population.Methods From 2003 to 2004, people aged t≥40 years in a community of Fengxian district in Shanghai were selected by cluster sampling. Out of 11 791 individuals who were selected, 10 565 met the inclusion criteria and responded to the investigation. By face to face interview, a cross-sectional survey was carried out, using a questionnaire for risk factors of stroke. Height, weight and blood pressures were measured and cerebrovascular hemodynamic parameters (CVHP) were checked. Age and gender distribution of over weight and obesity in the population were described. Using 60 year as cut-off point, participants were grouped into three: normal, over weight and obesity by body mass index. Level of stroke risk factor exposure between groups was compared and logistic regression model was used for multiple analyses. Results Proportions of over weight and obesity were 28.5 percent and 4.1 percent in male and 26.3 percent and 4.2 percent in female (P=0.045 ). Systolic and diastolic blood pressure in over weight group were (132.5±19.4)ram Hg and (83.9±10.5)mm Hg(1 mm Hg= 0.133 kPa),which were higher than that in normal weight group and lower than that in obese group (P<0.05). Exposure rate of heart disease,family history of stroke in < 60 year old group and diabetes in ≥60 year group increased along with the increase of weight. Exposure rate of hypertension, abnormality of CVHP score in both age groups were also increased with the increase of weight. Data from multiple logistic regression indicated that hypertension,family history of stroke and heart disease, CVHP score below 75 points, sex and age were independent factors of over weight and obese. Conclusion The prevalence of over weight or obesity in a community-based population among aged 40 years or over was around 30 percent. The overall exposure rate of stroke risk factors were increasing along with the increase of weight, especially for those in the middle age.

Baseline study and analysis on a stroke risk factor-related cohort in Fengxian county of Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the exposed level of stroke risk factors in Fengxian county of Shanghai and the relationships between risk factors and stroke.</p><p><b>METHODS</b>Community based populations including 10,565 individuals aged 40 years old and over were cluster sampled from Fengxian county in 2003 or 2004. Status of exposure on common risk factors such as hypertension, cardiovascular disease, diabetes, family history of stroke, cigarette smoking, alcohol intake were gathered while cerebral vascular hemodynamic index (CVHI) was examined, with CVHI score below 75 points as abnormal. During 2003 to 2006, 78 stroke cases occurred. The relationships between risk factors and stroke were analyzed by univariate and Cox proportional hazards regression models.</p><p><b>RESULTS</b>Rates of exposure regarding hypertension, cardiovascular disease, diabetes, family history of stroke, obesity (BMI > or = 28 kg/m2), smoking, drinking and CVHI score abnormal were 21.14%, 6.72%, 1.88%, 5.63%, 4.17%, 34.96%, 17.81% and 29.43%, respectively. Data from Univariate analysis indicated that relative risk (95% CI) of above-mentioned risk factors were 2.76 (1.76-4.32), 2.19 (1.16-4.14), 1.52 (0.38-6.19), 1.58 (0.69-3.62), 1.24 (0.45-3.38), 1.75 (1.12-2.73), 2.10 (1.30-3.39) and 12.72 (7.02-23.06), respectively. Results from Cox proportional hazards regression models analysis showed that cigarette smoking, CVHI score abnormal were screened into equation.</p><p><b>CONCLUSION</b>Among all the risk factors, rate of hypertension was the highest while hypertension, cardiovascular disease, cigarette smoking, alcohol intake and abnomal CVHI score had remarkable etiological correlations to stroke. Abnormal CVHI score, cigarette smoking seemed to be the independent forecasting factors related to stroke.</p>

Major causes of death among male steelworkers in Beijing: a prospective study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the major causes of death and risk factors among male steelworkers in Beijing.</p><p><b>METHODS</b>The study included 5137 men from the cohort of Beijing Capital Steel and Iron Company. The baseline survey was performed in 1974, 1979 and 1980 and the final follow-up evaluation was made in 2001 with a mean follow-up of 20.8 years. Causes of death were coded according to the Ninth Revision of International Classification of Diseases (ICD-9). The mortality was calculated by person-years of follow-up and age-standardized according to the 2000 census data in China. Cox proportional-hazards models adjusting for risk factors were used to estimate the relative risk of death.</p><p><b>RESULTS</b>There is 760 deaths during follow-up. Age-standardized mortality from all causes was 643.0 per 100,000 person-years. The three leading causes of death were malignant neoplasms (mortality, 231.3 per 100,000 person-years), cerebrovascular diseases (mortality, 139.3 per 100,000 person-years) and heart diseases (mortality, 96.4 per 100,000 person-years). The multivariate-adjusted relative risk of death and the population attributable risk proportion for risk factors were as follow: cigarette smoking (95% CI, 1.174 to 1.765); hypertension (95% CI, 1.370 to 1.904) and hypercholesterolemia (95% CI, 1.057 to 1.537).</p><p><b>CONCLUSIONS</b>Our study indicates that malignant neoplasms, cerebrovascular diseases and heart diseases were major causes of death among male steelworkers. Furthermore, cigarette smoking, hypertension and hypercholesterolemia are leading preventable risk factors for death.</p>

Baseline study on a stroke-related cohort in the rural community of Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To present data from a baseline investigation on stroke-related cohort population in rural area of Shanghai.</p><p><b>METHODS</b>A cross-sectional study was carried out in a cluster sampling population aged 40 years and over. General information and data on common risk factors in the population were gathered and cerebral vascular hemodynamic indexes were checked. Hemodynamic score was estimated according to single indexes by unified methods. 5335 persons who had met the inclusion criteria were enlisted in the study. Exposure level of risk factors, prevalence of stroke, and hemodynamic indexes were analyzed and distributional characteristics were described.</p><p><b>RESULTS</b>Exposure rate of hypertension, heart disease, diabetes, family history of hypertension, overweight or obesity in males were 31.74%, 6.09%, 1.16%, 3.22%, 17.64%, 29.68% and were 32.76%, 9.22%, 1.55%, 3.84%, 19.22%, 29.44% in female respectively. Standard prevalence of stroke was 1167.3/100000, which in male was significantly higher than that in female (P < 0.05). The change of cerebral vascular hemodynamic indexes was significantly associated with age. Hemodynamic score in 21.3% of the subjects was below 75 points.</p><p><b>CONCLUSIONS</b>Among population of 40 years old and over in rural areas, hypertension was the principal risk factor regarding the rate of stroke. Prevalence of stroke in males was significantly higher than that in females. Abnormal rate of hemodynamic score was about 20% in this population.</p>

Effectiveness of Nao'an Capsule on stroke prevention among high risk population in Nanhui, Shanghai / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of stroke prevention among high risk population, using Nao'an Capsules.</p><p><b>METHODS</b>Participants were selected from 696,558 residents in Nanhui, using county of Shanghai city. Individuals aged 35 years old and over with at least one risk factor exposure to stroke, received cerebral vascular hemodynamic examination. 18,271 cases meeting the criteria of cerebral vascular hemodynamic indexes accumulative score below 70 points were defined as individuals with high-risk and targets to receive intervention. According to the willingness of the participants, 10,313 cases received Nao'an Capsules for intensive intervention based on general intervention measures compared to 7958 cases only receiving general intervention. After the implementation of intervention, incidence and mortality rates of stroke and the effectiveness of three-year intervention were studied.</p><p><b>RESULTS</b>Incidence of stroke in Nao'an Capsules group was significantly lower than that of the general intervention (P < 0.01) with 53.8% in males and 58.4% in females. The relative risk (RR) in two gender groups were 0.46 (0.33 - 0.64) and 0.39 (0.30 - 0.50) respectively. Multiple logistic regression analysis indicated that the history of hypertension, accumulative score of cerebral vascular hemodynamic indexes, age, gender and Nao'an Capsules intervention were the variables selected into the equation and significantly related to stroke. Among the variables, Nao'an Capsule was the strongest factor with a RR of 0.41.</p><p><b>CONCLUSION</b>Incidence of stroke in Nao'an Capsule intervention group was significantly lower than that in the general intervention group after 3 years of intervention, suggesting that Nao'an Capsule intervention was the strongest factor affecting stroke occurrence in individuals at high-risk.</p>

China coronary secondary prevention study (CCSPS): outcomes from analysis of coronary heart disease patients with diabetes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To elucidate whether lipid-lowering therapy with Xuezhikang can induce a decrease of cardiac events and an attenuation of total mortality in coronary heart disease (CHD) patients with diabetes.</p><p><b>METHODS</b>We designed a random, double-blinded, placebo controlled clinical trial in selected 591 patients. All patients were administrated with capsule Xuezhikang (0.6 g, Bid) or placebo in addition to conventional therapy. The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and death from CHD.</p><p><b>RESULTS</b>(1) The incidence of CHD events and that of death from CHD were reduced by 50.8% (P = 0.0008) and by 44.1% (P = 0.0246) in treatment group, respectively; Also, the incidence of nonfatal myocardial infarction was reduced by 63.8% (P = 0.0151). (2) The incidence of stroke, tumor, and PCI/CABG were decreased by 20.2%. (3) The total mortality were lowered by 44.1% in treatment group (P = 0.0097).</p><p><b>CONCLUSION</b>Xuezhikang can effectively reduce the incidence of cardiac events and total mortality in CHD patients with diabetes.</p>

A 20-year prospective study on risk factors for myocardial infarction of 5,137 men in Capital Steel and Iron Company / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify independent risk factors for myocardial infarction (MI) in Chinese men and to develop a model to predict risk profile of an individual suffering MI.</p><p><b>METHODS</b>Study sample included 5 137 men aged 45.2 +/- 7.8 years who came from a cohort in Beijing Capital Steel and Iron Company, based on the three surveys on coronary heart disease conducted in 1974, 1979 and 1980, respectively. Demographic data and other risk factors, such as life style, medical history, blood pressure, total serum cholesterol level (TC), etc. were collected according to the same protocol in 1980. All the participants were followed up for MI in an average period of 20.84 years until 2001.</p><p><b>RESULTS</b>(1) There were 122 cases with MI identified during the period of follow-up, with an incidence of MI 117.4 per 100 000 person-years. Age of more than 50, smoking, higher systolic and diastolic blood pressure (SBP and DBP) levels, higher TC all were identified as important risk factors of MI. (2) Incidence of MI increased with TC. An increment of 0.52 mmol/L of TC significantly increased relative risk of MI by approximately 40% after adjusted for age, blood pressure and smoking. (3) An increment of 20 mm Hg in SBP or 10 mm Hg in DBP associated with a 40% increase in incidence of MI, adjusting for age, TC and smoking. (4) Smoking was the most risky factors for MI. Smokers had 2.3 times risk of MI, after as compared to non-smokers (or its incidence increased by 137%), after adjusting for blood pressure, TC and age, etc. (5) Incidence of MI increased by 20% with increment of five-year of age in those aged over 50 (P < 0.05), after adjusting for blood pressure, TC and smoking. And, (6) finally, based on multivariate logistic and Cox regression analyses, a model containing several risk factors, such as age, blood pressure, TC and smoking, was developed to predict individual's risk for afflicting MI.</p><p><b>CONCLUSIONS</b>Results of this prospective study showed several established risk factors for MI, including age, blood pressure, TC and smoking all as independent predictors of MI in Chinese men. It is clear and rational that intervention and modification of those traditional risk factors can lead to a decrease in coronary events in Chinese population.</p>

Changes of cerebral vascular hemodynamics from normal population to stroke / 中华流行病学杂志

<p><b>OBJECTIVE</b>To probe into changes of cerebral vascular hemodynamics indexes (CVHI) from normal population to different clinical stage before and after occurring of stroke.</p><p><b>METHODS</b>Participants were selected from 25,355 stroke cohort study population aged 35 years and over in Northeast of China and 55 acute stroke patients were selected from Fuzhou PLA General Hospital. CVHI indexes were checked during baseline investigation or within one week after acute stroke. Participant enlisted in the study were divided into following 5 groups, normal population, high risk population, individuals before stroke, acute stroke patients and convalescence stroke patients. Characteristics of CVHI indexes in different population were analyzed and compared.</p><p><b>RESULTS</b>V(min) of cerebral vascular in previous defined 5 group participants were 11.39 +/- 3.27, 9.66 +/- 3.18, 6.71 +/- 3.30, 4.13 +/- 1.27, 6.78 +/- 3.09, respectively. V(mean) and V(max) were with the same decreasing trends as V(min). However, RV in 5 group participants were 62.35 +/- 21.11, 82.32 +/- 31.16, 122.72 +/- 52.73, 137.46 +/- 49.56 and 115.89 +/- 55.51, respectively. Zcv, WV, DR and CP were also with the same increasing trends as RV. Abnormal rate of CVHI score (< 75 points) from normal population to convalescence stroke patients were 13.3%, 34.7%, 74.1%, 100% and 66.7%, respectively.</p><p><b>CONCLUSION</b>From normal population to clinical stage of stroke, cerebral vascular velocity showed decreasing trends while other indexes, such as RV, Zcv, WV, DR and CP were increasing.</p>

The reference range of cerebrovascular hemodynamics indexes parameters / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the reference range of cerebrovascular hemodynamics indexes (CVHI) in a sampling population.</p><p><b>METHODS</b>Fourteen thousand, four hundred and eighty participants without history of stroke or exposure to risk factors were screened from 26 cities in Northeast China, North China, East China, Northwest China, South China, and Southwest China in the prospective study on stroke intervention. CVHI were checked and 95% confidence intervals were calculated using normal distribution methods, which were grouped by age, sex, area, and check positions.</p><p><b>RESULTS</b>Characteristics of CVHI 95% confidence intervals showed that low limit of carotid blood velocity as V(max), V(min), V(mean) decreased, but upper limit of cerebral RV, Zcv, WV, DR and CP increased with the increase of age. However, Q(mean) and DP did not show significant trends of age difference. Low limit of Q(mean), V(max) and upper limit of RV, DR, CP and DP in males were higher than that in females while upper limit of WV and Zcv in females were higher than that in males. Left carotid low limit of Q(mean), V(mean), V(max), V(min), and upper limit of WV, Zcv and CP were higher than that of the right but upper limit of RV, DR and DP were lower than that of the right. There were no obvious differences between areas.</p><p><b>CONCLUSION</b>Obvious differences of CVHI 95% confidence intervals ranges were found between age groups, sex, and checking positions, respectively, suggesting that the reference ranges of CVHI to be estimated by every subgroup.</p>

An evaluation on effectiveness of worksite-based intervention for cardiovascular disease during 1974 - 1998 in capital iron and steel company of Beijing / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the feasibility and effectiveness of worksite-based cardiovascular disease (CVD) prevention and control program in urban population of China.</p><p><b>METHODS</b>Worksite-based intervention program was implemented 110 000 employees at Capital Iron and Steel Company of Beijing (CISC) focusing on primary prevention for CVD and control of hypertension. Intervention components comprised of infrastructure setting-up, health education and health promotion, professional training, detection and management of hypertensive patients, and reasonably readjusting their diet structure focusing on salt intake reduction, reducing their overweight, quitting smoking, and restricting alcohol consumption in high-risk population. Changes in level of risk factors, incidence and mortality of stroke and coronary events and their trend were evaluated between the intervention group at CISC and eight simultaneously parallel reference groups in other provinces outside Beijing with population surveillance data.</p><p><b>RESULTS</b>Major risk factors for CVD, including blood pressure, body mass index and serum cholesterol level, decreased relatively in intervention population at CISC during 1974 to 1998, while those in majority of eight parallel reference groups at different provinces of China significantly increased at the same time. Systolic blood pressure (SBP) decreased by 0.8 mm Hg and 4 mm Hg in average for men and women, respectively, and their diastolic blood pressure (DBP) remained the same as baseline for both men and women at CISC, while SBP increased by (2 - 11) mm Hg and (6 - 8) mm Hg in average for men and women, respectively in reference groups, and DBP increased by (2 - 6) mm Hg in average for men in five of eight reference groups, and by (3 - 6) mm Hg for women in four of eight reference groups. Serum level of cholesterol decreased by 0.26 mmol/L in women and slightly increased for men at CISC, and increased by (0.35 - 0.97) mmol/L for men and (0.29 - 1.05) mmol/L for women in all reference groups. Prevalence of overweight increased by 58.7% for men and 11.3% for women at CISC and increased by one to 22 folds in eight reference groups. Awareness of health knowledge improved significantly with an average net reduction of SBP/DBP of (2.5/2.2) mm Hg in the enforced intervention group at CISC than that in general intervention groups. Incidence and mortality rates of stroke decreased by 54.7% and 74.3%, respectively in intervention group at CSIC, but those of coronary events slowly increased with fluctuation.</p><p><b>CONCLUSION</b>Worksite-based comprehensive intervention for CVD prevention and control was feasible and cost-effective in decreasing risk factors for CVD, incidence and mortality rate of stroke in population of urban areas of China.</p>