Prevalence, Incidence, Prognosis, Early Stroke Risk, and Stroke-Related Prognostic Factors of Definite or Probable Transient Ischemic Attacks in China, 2013

Abstract

The epidemiological characteristics of transient ischemic attacks (TIAs) in China are unclear. In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TIA in China using a complex, multistage, probability sampling design. Results showed that the weighted prevalence of TIA in China was 103.3 [95% confidence interval (CI): 83.9–127.2] per 100,000 in the population, 92.4 (75.0–113.8) per 100,000 among men, and 114.7 (87.2–151.0) per 100,000 among women. The weighted incidence of TIA was 23.9 (17.8–32.0) per 100,000 in the population, 21.3 (14.3–31.5) per 100,000 among men, and 26.6 (17.0–41.7) per 100,000 among women. No difference in average prognosis was found between TIA and stroke in the population. Weighted risk of stroke among TIA patients was 9.7% (6.5–14.3%), 11.1% (7.5–16.1%), and 12.3% (8.4–17.7%) at 2, 30, and 90 days, respectively. The risk of stroke was higher among male patients with a history of TIA than among female patients with a history of TIA (OR: 2.469; 95% CI: 1.172–5.201; P = 0.018), and higher among TIA patients with hypertension than among TIA patients without hypertension (OR: 2.671; 1.547–4.613; P < 0.001). It can be concluded that there are an estimated 1.35 million TIA patients nationwide, with 0.31 million new cases of TIA annually in China. TIA patients were not better managed prior to a stroke event. Early risk of stroke among TIA patients is high. Sex and hypertension may be stroke-associated prognostic factors among TIA patients. TIA clinics and surveillance should be integrated into the national health-care system.

Annual rates of and factors influencing inpatient and outpatient transient ischaemic attacks in Chinese population: a nationally representative cross-sectional survey

“…A community-based stroke registry in three cities in China showed that only 16.9% of patients with stroke were aware that their initial symptom represented a stroke 4. In fact, over half of TIA patients with stroke have already developed a stroke within 2 days of symptom onset 1 21. This implies that TIA care should be focussed on pre-TIA care as well as inpatient and outpatient care.…”

“…A nationally representative cross-sectional survey on strokes and TIAs was conducted in 157 disease surveillance points (DSPs) or survey sites of the 31 provincial regions in mainland China from 1 September 2013 to 31 December 2013 which was described in detail in previous studies 1 5. Briefly, participants with suspected stroke or TIA symptoms were screened from the sampled populations by China’s Centers for Disease Control and Prevention (CDC) investigators and further interviewed by neurologists in this study.…”

“…In this study, a TIA was defined as the sudden onset of a focal neurological symptom or sign lasting less than 24 hours, presumably brought on by a transient decrease in blood supply that rendered the brain ischaemic in the area producing the symptom 1. In this epidemiological survey, only definite TIAs (the sudden onset of transient limb paralysis, with or without other signs, lasting up to 24 hours and leaving no significant deficits) or probable TIAs (other transient focal neurological deficits lasting up to 24 hours) were diagnosed according to the TIA definition after the neurologist completed a physical examination and reviewed disease histories and previous medical documents, including cardio-cerebro-vascular-related medical records, CT/MRI scans.…”

“…In China, there are an estimated 1.35 million patients who have ever had definite or probable transient ischaemic attacks (TIAs) nationwide, with 0.31 million new cases of TIA annually 1. TIA patients are not managed well prior to a stroke in China1, although the early assessment and management of TIAs and minor strokes can result in an 80% reduction in the incidence of early recurrent strokes 2 3. It is particularly urgent for TIA care to be integrated into the national healthcare system.…”

Evidence‐based practice guideline on integrative medicine for stroke 2019

“…Transient ischemic attack is a warning sign of ischemic stroke. A nationwide multicenter study in China found that 12.3% of patients with transient cerebral ischemia progressed to stroke within 90 days 44 . A systematic review that included 13 RCTs 45 showed that the addition of Chinese herbal medicine to a conventional secondary prevention strategy reduced the stroke event rate in 6 months following a transient ischemic attack (RR = 0.13, 95% CI 0.0‐0.97, n = 148) and at 12 months (RR = 0.42, 95% CI 0.23‐0.75, n = 446).…”