Stroke Recurrence as a Challenge for Countries

Chen, Mao; Li, Mengfeng

doi:10.1001/jamanetworkopen.2022.19698

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…[1] The high incidence and recurrence of stroke and disability and mortality associated with it place a heavy burden on society, making stroke a major challenge for all countries today. [2] With the gradual increase in life expectancy in the Chinese population, the incidence of stroke has risen sharply and the age of stroke onset tends to be lower than it was previously, with the average age of ischaemic stroke falling by 0.22 years from 1992 to 2014. [3,4] Although the cumulative incidence of recurrent stroke in the Chinese population fell from 15.5% to 12.5% between 2017 and 2018, more than 1 in 10 patients experience a recurrent stroke within 1 year.…”

Section: Introductionmentioning

confidence: 99%

Association of elevated serum urea nitrogen and the remaining renal function indicators with recurrence of acute ischaemic stroke, with mediating and interacting effects with blood inflammatory indicators

wang,

Zhang,

Zhu

et al. 2023

Preprint

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Background and purpose: The relationship between blood urea nitrogen (BUN) and other markers of renal function and the recurrence of acute ischemic stroke (AIS) have been scarcely reported. Inflammatory mechanisms may play a role in these relationships.The aims of this study were to investigate the relationship between BUN and recurrence of AIS and to explore the roles of inflammatory indicators in these relationships. Methods: A total of 10,973 patients hospitalised for cerebral infarction from 2015 to 2020 were included in this study. BUN, creatinine (CR), uric acid (UA), BUN/CR, UA/CRand BUN/UA were divided into four groups. Cox regression and restricted three-sample bar regression models were used to evaluate the clinical correlations between BUN and other indicators of renal function and ischaemic stroke recurrence. Results:Among the indicators, the risk of ischaemic stroke recurrence was increased by 117.0% (hazard ratios (HR)= 2.170, 95% confidence interval (CI)=1.816–2.593, P<0.001) in patients with the fourth quartile BUN level (Q4 ≥ 6.4 mmol/L), using the first quartile level (Q1<4.3 mmol/L) as the reference value. BUN predicted a greater risk ratio of ischaemic stroke recurrence over 5 years than did the remaining indicators of renal function. We also found that inflammatory markers play a mediating role. Conclusions:Higher BUN levels were associated with recurrent ischaemic stroke events within 5 years. And, the inflammatory markers white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) mediated and interacted with BUN and ischaemic stroke recurrence.

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Section: Introductionmentioning

confidence: 99%

Association of elevated serum urea nitrogen and the remaining renal function indicators with recurrence of acute ischaemic stroke, with mediating and interacting effects with blood inflammatory indicators

wang,

Zhang,

Zhu

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…In high-income countries, the incidence, mortality, and disability rates of stroke have significantly declined due to aggressive primary and secondary prevention efforts for stroke. However, people in low- and middle-income countries have continued to bear a significant economic and health burden as a result of stroke over the past few decades due to population explosions, aging populations, and growing incidences of intervenable risk factors for stroke ( 1 , 2 ). Acute ischemic stroke (AIS) which is prevalent in China's cerebrovascular disease is at an increasing stage, and after the onset of AIS, ~17.7% of the population will experience a recurrence of cerebral infarction ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Predictive value of ApoB/ApoA-I for recurrence within 1 year after first incident stroke

Lin,

Si,

Wang

2024

Front. Neurol.

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BackgroundApoB/ApoA-I ratio is a reliable indicator of cholesterol balance, particularly in the prediction of ischemic events risk. The aim of this study was to investigate the prognostic value of ApoB/ApoA-I for stroke recurrence within 1 year after the first incident.MethodsWe retrospectively included patients who were first diagnosed with acute (<7 days after onset) ischemic stroke. Blood samples were collected on admission, and serum ApoB and ApoA-I concentrations were measured. We analyzed the relationship between ApoB/ApoA-I ratio and ischemic stroke recurrence within 1 year.ResultsA total of 722 patients with acute ischemic stroke were included, of whom 102 experienced stroke recurrence within 1 year, with a recurrence rate of 14.1%. Serum ApoB/ApoA-I concentrations on admission were higher in patients with stroke recurrence at 1 year compared with those with a good prognosis (P < 0.001). The Kaplan-Meier survival curve revealed a significant difference in cumulative stroke recurrence rates across ApoB/ApoA-I tertiles (log-rank P-value < 0.001). A positive correlation between the ApoB/ApoA-I ratio and the risk of stroke recurrence within 1 year was demonstrated using Cox regression analysis, which remained significant after adjusting for traditional risk factors [hazard ratio (HR) 4.007, 95% confidence interval (CI) 1.661–9.666]. This relationship was particularly strong in patients with LAA stroke (HR 4.955, 95% CI 1.591–15.434). Subgroup analysis further revealed that a high ApoB/ApoA-I ratio was strongly associated with stroke recurrence regardless of whether patients had high or low LDL-C levels.DiscussionApoB/ApoA-I ratio, measured during the acute phase of the first stroke, was positively correlated with the risk of stroke recurrence within 1 year.

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“…In 2019, there were ~12 million incident cases of stroke, of which 32.8% were in China ( 1 ). Although the stroke incidence rate is increasing, the stroke mortality rate has been decreasing over the past few decades, resulting in a huge number of stroke survivors globally ( 2 ). As these stroke survivors need continuous health management and risk control, the spending on post-stroke care causes an economic burden ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

An economic evaluation of a primary care-based technology-enabled intervention for stroke secondary prevention and management in rural China: a study protocol

et al. 2023

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IntroductionSecondary prevention of stroke is a leading challenge globally and only a few strategies have been tested to be effective in supporting stroke survivors. The system-integrated and technology-enabled model of care (SINEMA) intervention, a primary care-based and technology-enabled model of care, has been proven effective in strengthening the secondary prevention of stroke in rural China. The aim of this protocol is to outline the methods for the cost-effectiveness evaluation of the SINEMA intervention to better understand its potential economic benefits.MethodsThe economic evaluation will be a nested study based on the SINEMA trial; a cluster-randomized controlled trial implemented in 50 villages in rural China. The effectiveness of the intervention will be estimated using quality-adjusted life years for the cost-utility analysis and reduction in systolic blood pressure for the cost-effectiveness analysis. Health resource and service use and program costs will be identified, measured, and valued at the individual level based on medication use, hospital visits, and inpatients' records. The economic evaluation will be conducted from the perspective of the healthcare system.ConclusionThe economic evaluation will be used to establish the value of the SINEMA intervention in the Chinese rural setting, which has great potential to be adapted and implemented in other resource-limited settings.

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Stroke Recurrence as a Challenge for Countries

Cited by 4 publications

References 7 publications

Association of elevated serum urea nitrogen and the remaining renal function indicators with recurrence of acute ischaemic stroke, with mediating and interacting effects with blood inflammatory indicators

Association of elevated serum urea nitrogen and the remaining renal function indicators with recurrence of acute ischaemic stroke, with mediating and interacting effects with blood inflammatory indicators

Predictive value of ApoB/ApoA-I for recurrence within 1 year after first incident stroke

An economic evaluation of a primary care-based technology-enabled intervention for stroke secondary prevention and management in rural China: a study protocol

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