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Objective:To establish a 10-year comparison table of cerebrovascular function score and first stroke risk, and to provide a new method for screening of high-risk population of stroke.Methods:In the beginning of 2003, a cohort for studing stroke risk factors in those aged 40 years and over was established in a community of Shanghai by cluster sampling. The common risk factors of stroke were investigated with a unified questionnaire, and the cerebrovascular function (cerebral vascular hemodynamic indexes, CVHI) was measured. The baseline study was completed from April to June 2003 and December 2004 to January 2005, respectively. The incident of first stroke and all cause of death were followed up year by year. The follow-up period was up to December 31, 2014. The 10-year incidence of first stroke was calculated according to the baseline score of cerebrovascular function, and the score-risk control table was established to estimate 10-year first stroke risk in each score group. The role of cerebrovascular function score in stroke was also estimated.Results:The follow-up term of 10 565 participants was (10.26±2.00) years, and 350 patients had first stroke during the follow-up. The trend 10-year incidence of first stroke both in men and women was significantly increased with the decrease of the score of cerebrovascular function (trend χ2=296.125, P<0.01). As the 10-year risk of first stroke was higher than 5% and higher than 10%, the corresponding CVHI score was lower than 70 and 40 points in males and lower than 30 and 20 points in females. When the scores of cerebral vascular function were divided by every 25 points, incidence of first stroke in each group from top to bottom was 1.9%, 4.7%, 10.8%, 15.2% in males and 1.6%, 4.4%, 4.8%, 11.4% in females, respectively. As compared to the top, the relative risk (95% CI) of first stroke in the lower groups was 2.61(1.67-4.07), 6.46(4.22-9.89), 9.74(6.53-14.52) for males and 2.82(1.93-4.12), 3.15(1.99-4.99), 8.12(5.65-11.68) for females, respectively. Multivariate analysis showed that the factors being selected into the regression equation were cerebrovascular function score, age, hypertension history, stroke family history and smoking history, among which the role of cerebrovascular function score was the strongest. Conclusion:The risk of first stroke increases significantly with the decrease of cerebrovascular function score, which can be used to assess the 10-year risk of first stroke.
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Objective:This study aimed to analyze and summarize the implementation of the primary prevention program for stroke in Shanghai rural community and evaluate its preventive effect.Methods:A cluster sampling method was used to select approximately 50 000 community natural population from a town in Fengxian District of Shanghai. A primary stroke prevention program was established and implemented in the community from 2008 to 2010 and from 2012 to 2015. The prevention program inclueded stroke health education for the whole population, screening of high risk population of stroke, and therapeutic intervention and management plan for individuals aged≥50 years. The intervention measures were followed up every 2 months. From 2008 to 2015, new stroke cases were monitored dynamically and reviewed annually with classification of stroke diagnosis. The effect of community primary prevention of stroke program was evaluated by the dynamic changes in stroke incidence. Results:From 2008 to 2015, a total of 422 600 individuals were monitored, including 20 500 men and 217 600 women. In 2008, 7 828 individuals were screened and 2 129 individuals were at high risk of stroke were screened, with a high risk rate of 27.2%. In 2012, 2 877 individuals were screened, and 725 individuals were at high risk of stroke were screened, with a high risk rate of 25.2%. The standardized incidence of stroke in this community was 158.1, 105.4, 86.6, 77.6, 89.3, 77.4, 50.7, and 42.3 per 100 000 respectively. The overall incidence image roughly showed a downward trend except 2012(trend test P<0.01). There was no significant difference in the incidence of stroke between men and women in each year. The incidence of stroke increased significantly with age (trend test P<0.01). The age composition of stroke patients is slightly different between different sexes. The proportion of male patients with stroke aged <70 years was significantly higher than that of female patients with stroke, while the proportion of female patients with stroke age>70 years was significantly higher than that of male patients with stroke ( P<0 .01). Cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage accounted for 20.76%, 75.14%, and 4.10%, respectively. Conclusion:Based on lifestyle intervention and treatment and control of risk factors, screening high-risk individuals for therapeutic intervention in community population can significantly reduce the incidence of stroke.
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Objective@#This study aimed to analyze and summarize the implementation of the primary prevention program for stroke in Shanghai rural community and evaluate its preventive effect.@*Methods@#A cluster sampling method was used to select approximately 50 000 community natural population from a town in Fengxian District of Shanghai. A primary stroke prevention program was established and implemented in the community from 2008 to 2010 and from 2012 to 2015. The prevention program inclueded stroke health education for the whole population, screening of high risk population of stroke, and therapeutic intervention and management plan for individuals aged≥50 years. The intervention measures were followed up every 2 months. From 2008 to 2015, new stroke cases were monitored dynamically and reviewed annually with classification of stroke diagnosis. The effect of community primary prevention of stroke program was evaluated by the dynamic changes in stroke incidence.@*Results@#From 2008 to 2015, a total of 422 600 individuals were monitored, including 20 500 men and 217 600 women. In 2008, 7 828 individuals were screened and 2 129 individuals were at high risk of stroke were screened, with a high risk rate of 27.2%. In 2012, 2 877 individuals were screened, and 725 individuals were at high risk of stroke were screened, with a high risk rate of 25.2%. The standardized incidence of stroke in this community was 158.1, 105.4, 86.6, 77.6, 89.3, 77.4, 50.7, and 42.3 per 100 000 respectively. The overall incidence image roughly showed a downward trend except 2012(trend test P<0.01). There was no significant difference in the incidence of stroke between men and women in each year. The incidence of stroke increased significantly with age (trend test P<0.01). The age composition of stroke patients is slightly different between different sexes. The proportion of male patients with stroke aged <70 years was significantly higher than that of female patients with stroke, while the proportion of female patients with stroke age>70 years was significantly higher than that of male patients with stroke (P<0.01). Cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage accounted for 20.76%, 75.14%, and 4.10%, respectively.@*Conclusion@#Based on lifestyle intervention and treatment and control of risk factors, screening high-risk individuals for therapeutic intervention in community population can significantly reduce the incidence of stroke.
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Objective To evaluate the efficacy of the traditional Chinese medicine NAOAN capsule in primary prevention of stroke in high?risk populations. Methods A multicenter, randomized controlled study was performed in community setting, involving 1 088 individuals at high risk of stroke, with cerebrovascular function scores<75 and 10?year Framingham stroke risk ≥6%. Subjects were recruited in communities at Beijing, Shanghai, Changsha, and Chengdu communities, through resident committees or the village unit. A total of 559 subjects were randomized into a group treated with the NAOAN capsule, and 529 subjects in an aspirin treatment group. Follow?up was performed every 2 months for 2 years. At the mid?point and end of the intervention, we compared cerebrovascular function differences between the 2 groups. Results During the 2?year community trial, 531 subjects in the NAOAN capsule group and 465 in the aspirin group followed the protocol. Cerebrovascular function scores increased from 45.2±19.7 at baseline to 61.7±26.5 after the 2?year trial (t=－12.931, P<0.001) in the NAOAN capsule group, and from 47.2±18.9 at baseline to 53.7 ± 25.1 (t=－5.058, P<0.001) in the aspirin group; greater increases in cerebrovascular function scores were found in the NAOAN capsule group than that in the aspirin group (t=4.906, P<0.001). Conclusions Cerebrovascular function in individuals at high risk of stroke was improved by taking NAOAN capsule. Cerebrovascular function scores improved more with NAOAN capsules than with aspirin.
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Objective To investigate the changes of cerebrovascular hemodynamic accumulative score in health checkup population and their influencing factors.Methods A total of 1 840 people aged 23-88 years were checked by CVHI and accumulative scores were calculated.The general information,blood biochemistry,highly sensitive C-reaction protein (hs-CRP),homocysteine (Hcy),carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (baPWV) were also collected during the corresponding period.Results The proportion of abnormal CVHI accumulative score (＜75 points) was increasing with age.Compared with the normal CVHI accumulative score (≥75 points) group,the proportion of hypertensive disease,diabetes and stroke family history was significantly higher in the abnormal group (P＜ 0.05).In addition,the levels of age,body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),fasting plasma glucose (FPG),hs-CRP,Hcy,CIMT and baPWV were also significantly increased in the abnormal group (P＜0.05).Correlation analysis showed a negative correlation between CVHI accumulative score and age,history of hypertension,diabetes,BMI,WC,SBP,DBP,LDL-C,TG,FPG,hs-CRP,Hcy,baPWV (P＜ 0.05),but a positive correlation with HDL-C (P＜0.05).Multiple factor analysis determined that age [OR(95％C1):1.017(1.002-1.033)],history of hypertension [OR(95％CI):1.510(1.096-2.081)],BMI [OR(95％CI):1.235(1.135-1.344)],SBP [OR(95％CI):1.044(1.030-1.059)],LDL-C [OR(95％CI):1.673(1.444-1.937)],TG [OR(95％CI):1.116(1.035-1.204)],hs-CRP [OR(95％CI):1.037(1.003-1.073)],Hcy [OR(95％CI):1.099(1.062-1.136)],baPWV [OR(95％CI):1.001(1.000-1.002)] were being selected into the regression model (P＜0.05),and they were independent influencing factors of decreased CVHI accumulative scores.Conelusion The decreased CVHI accumulative score has a significant relationship with exposure levels of risk factors in stroke.Therefore,we conclude that the detection of CVHI is a convenient and feasible method to screen high risk individuals for stroke in middle and old aged population undergoing medical examination.
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Objective To analyze the relationships between body mass index (BMI), blood pressure and the cerebral vascular function in middle-aged population that underwent health checkup. Methods Participants from health management centers of Renmin Hospital of Hubei province, the Second Hospital Affiliated to Nanhua University, Hospital of Shandong Electric Power and Chinese People's Liberation Army No. 180 Hospital aged 45 to 64 years were selected from health checkup population by cluster sampling. Levels of height, weight and blood pressure as well as the cerebral hemodynamics were checked. Subjects were grouped according to age, BMI, systolic and diastolic blood pressure. The differences and distribution of cerebrovascular function scores (CVFS) between groups were compared and described. Moreover, the risk of stroke in the population was evaluated. Results Of the 17 258 individuals who met inclusion criteria, the abnormal rate (the score below 75 points) of CVFS was 20.9 percent. The CVFS in normal, overweight and obese groups were 91.0±15.4, 83.3±21.3, 70.3±26.5 and differences in all age groups were statistically significant (P<0.01). The CVFS in systolic blood pressure<120,120-139, 140-159,≥160 mmHg (1 mmHg=0.133 kPa) groups were 93.9±12.9, 86.5±18.9, 72.1±23.5, 56.2±25.7 and differences in all age groups were statistically significant (P<0.01). CVFS in normal diastolic pressure<80, 80-89, 90-99,≥100 mmHg groups were 91.0±16.1, 85.5±20.2, 75.4±23.6, 62.7±25.0 and the differences among all age groups were statistically significant (P<0.01). Conclusions The abnormal rate of cerebrovascular function integral and high risk stroke individuals in middle-aged health checkup people was approximately 21 percent. The overweight, obese and the high level of systolic and diastolic pressure may induce the injury of cerebrovascular function and the severity will increase with the level of BMI and blood pressure.
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Objective: To compare the accumulative scores of cerebrovascular hemodynamic parameters (CVHP) in different populations and to analyze the relationship between the change of accumulative scores and the risk of stroke. Methods: A total of 10 565 participants aged 40 years and above were selected from a cluster sampling community-based population. Their risk factors were investigated and CVHP was evaluated. The CVHP scores were accumulated by a unified approach, and the incidence of stroke was followed up. The participants were grouped into health adult, single factor exposure, multiple-factor exposure, and newly developed stroke during the follow-up period. The differences of CVHP accumulative scores and the change law among the 4 groups were compared respectively according to age and sex. Results: The accumu-lative scores of the mean (SD) CVHP in the health adult, single factor exposure, multiple-factor exposure, and newly developed stroke groups were 86.44 (20.69), 72.07 (28.10), 60.82(34.64), and4.01 (29.36) in men respectively, and they were 83.95 (22.19), 67.97 (29.73),59.91 (31.34), and 42.64 (28.00) in women respectively, which had a tendency to gradually decrease. The accumulative scores of CVHP and their distributions at the same age stage in all the 4 groups had significant differences (P ＜ 0.01 ). The accumulative scores of CVHP and their distributions for the same factors between all age groups also had significant differences (P ＜0. 01). Conclusions: The accumulative scores of CVHP had a tendency to gradually decrease from the health adults, risk factor exposure to high risk status before stroke. The decrease of the accumulative scores is closely associated with the increase of stroke risk, which can be used as a predictor of stroke.
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Objective To observe the changes of cerebrovascular hemodynamic index(CVHI) in atherosclerotic rabbits. Methods Twenty male New Zealand rabbits were randomly divided into two group: Twelve were atherosclerosis model (AS) group and eight were control group. Atherosclerosis model group were fed with high fat diet and control group were fed with ordinary diet. At 12th week, CVHI were measured in the common carotid artery with spectral analysis and the compliance of carotid was observed. Results In the AS group, the carotid artery maximal velocity (vmax) and minimal velocity (vmin) were significantly decreased (P
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Objective To probe into the relations between cerebrovascular hemodynamics indexes(CVHI),risk factors of stroke and risk of ischemic stroke.Methods A nested case-control design was used in the study.Participants were selected from a cohort in the northeast of China.151 ischemic stroke patients occurred during the follow-up term were defined as case group,and the same numbers of individuals,free of stroke,were selected randomly in the cohort and defined as control group.Odds ratio(OR) of CVHI score as well as other risk factors of stroke were estimated.Results Univariate analysis indicated that there were significant etiological relations between stroke and CVHI score,hypertension,heart disease and family history of stroke(P
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Objective To find out exposure level and distributional characteristics of risk factors for stroke in sampling population among communities. Methods Target population aged≥40 years were selected from Beijing,Shanghai,Fuzhou and Tangshan by cluster sampling and grouped by area,age and gender. They were investigated face to face with a questionnaire which included general information and common risk factors of stroke. Body height,weight and levels of blood pressures were measured. Exposure rate of risk factors and its distributional characteristics of area and population were described. Results 23 471 individuals were enlisted into data analysis. Exposure rate of hypertension,heart disease,diabetes,family history of stroke,obesity,cigarette smoking and alcohol drinking were 27.73%,14.14%,5.19%,15.95%,11.28%,28.7% and 16.6%,respectively. There were significant differences between areas for all factors (P
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<p><b>OBJECTIVE</b>To prospective examine the relationship between smoking, quitting and mortality in older Chinese men by in Xi'an, China.</p><p><b>METHODS</b>The design was a cohort analytic study. One thousand two hundred and sixty-eight retired male military veterans aged 60 or older were examined in 1987. At baseline, there were 388 never-smokers, 461 former smokers and 419 current smokers. Main outcome measure was all-cause and tobacco-associated mortality.</p><p><b>RESULTS</b>Through 1999, 299 had died, 943 were alive and 26 lost. The mean follow-up time was 11 years and total person-year of follow-up was 14 163. After adjusting for age, blood pressure, body mass index, total cholesterol, triglycerides, alcohol intake, exercise and existing diseases, using Cox proportional hazard regression model, the relative risks (95% confidence intervals) for ever-smoking, deaths resulting from all causes, chronic obstructive pulmonary disease (COPD), lung cancer and coronary heart disease (CHD) were 1.34 (1.02 - 1.76), 3.23 (0.95 - 10.91), 2.31 (0.95 - 5.61) and 1.60 (0.81 - 3.19) respectively. The risks increased significantly with increasing amount and duration of smoking. Compared with current smokers, former smokers had lower risks of total mortality (excess risk reduction of 56%) and from CHD death (93%), but had higher risks for COPD death (excess risk increased 174%).</p><p><b>CONCLUSIONS</b>Smoking is a major cause of death in older Chinese men and quitting can save lives. These results showing that higher risks of COPD death in former smokers with or without existing diagnosed COPD at baseline than those in current smokers could be explained by either the "healthy smoker effect" or the "ill quitter effect" or both. Early recognition of the significance of COPD symptoms followed by prompt quitting should be emphasized as strategies in the control of the growing tobacco epidemic.</p>
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Idoso , Humanos , Masculino , Pessoa de Meia-Idade , China , Estudos de Coortes , Doença das Coronárias , Mortalidade , Neoplasias Pulmonares , Mortalidade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica , Mortalidade , Fatores de Risco , Fumar , Mortalidade , Abandono do Hábito de Fumar , Taxa de Sobrevida , VeteranosRESUMO
<p><b>OBJECTIVE</b>To evaluate efficacy and optimal cut-off-point through cerebral vascular hemodynamic indexes (CVHI) examination to predict stroke.</p><p><b>METHODS</b>A number of 20,333 people at 35 years old and over were checked by CVHI and accumulative score was calculated according to the value of detected indexes. Risk factors of stroke were investigated simultaneously. One hundred and sixty-eight patients with stroke occurred during 4-year following up. Typical syndromes and signs stroke were used as golden standard to evaluate screening efficacy of CVHI.</p><p><b>RESULTS</b>Score of optimal cut-off-point of cerebral vascular hemodynamic indexes was under 75 in ROC curve analyses. Sensitivity, specificity, accuracy, positive and negative predictive values, positive and negative likelihood ratios as well as Youden's index for predicting stroke within 4 years after examination were found to be 87.50%, 67.70%, 67.86%, 2.21%, 99.85%, 2.71, 0.18 and 0.55 respectively. Sensitivity and positive predict values for predicting cerebral vascular thrombosis were superior to predicting cerebral hemorrhage. Positive predicting value in risk exposure population was higher than that of overall population. Coefficiency of variation of cerebral vascular hemodynamic examination was 4.03%. The agreement rate of examination between two physicians was 97.62% and Kappa value was 0.94.</p><p><b>CONCLUSION</b>The score of optimal cut-off-point of cerebral vascular hemodynamic indexes examination was 75. Both Efficacy and reliability for predicting stroke seemed to be good, especially for predicting cerebral vascular thrombosis.</p>