Trends and Risk Factors Associated With Stroke Recurrence in China, 2007-2018

Abstract

IMPORTANCERecurrent stroke rates have decreased substantially in Western countries. However, data on changes in stroke recurrence and risk factor patterns in China are limited. OBJECTIVE To systematically assess stroke recurrence trends by evaluating temporal improvement in guideline-recommended secondary prevention treatment performance and changes in risk factor patterns over 10 years in China. DESIGN, SETTING, AND PARTICIPANTS This post hoc cohort study was conducted based on data from the China National Stroke Registries (CNSRs, comprising 3 phases, I-III, from 2007-2018). Participants were patients with ischemic stroke who were enrolled in CNSR I or III within 7 days of symptom onset. Data were analyzed from September through November 2021. EXPOSURES Vascular risk factors included current smoking, alcohol consumption, hypertension, diabetes, coronary artery disease, atrial fibrillation, and low-density lipoprotein cholesterol (LDL-C) levels. MAIN OUTCOMES AND MEASURESThe cumulative incidence rates of stroke recurrence at 3, 6, and 12 months were calculated, and the performance of guideline-based secondary prevention treatments was investigated at each visit in CNSR I (2007-2008) and III (2015III ( -2018. Logistic regression models were used to evaluate changes in risk factor patterns for stroke recurrence based on data from CNSR I and III. RESULTSA total of 10 952 patients with ischemic stroke from CNSR I (6740 [61.5%] men; median [IQR] age, 67 [57-75] years) and 10 348 patients with ischemic stroke from CNSR III (7128 [68.9%] men; median [IQR] age, 63 [54-70] years) were selected. Over 10 years, the adjusted cumulative incidence of recurrent stroke within 12 months decreased from 15.5% (95% CI, 14.8%-16.2%) to 12.5% (95% CI, 11.9%-13.1%) (P < .001). Factors associated with increased risk of stroke in CNSR I that were still associated after 10 years included age per 10 years (CNSR I: odds ratio [OR], 1.24; 95% CI,

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“…Cardio-cerebrovascular disease is one of the most serious diseases that threaten human health today; its morbidity and mortality rates have surpassed those of tumor diseases and now rank first (Liberale et al, 2021;Xu et al, 2022). The heart and brain are the most closely related organs physiologically, and brain tissue relies on blood circulation driven by the heart to maintain normal physiological functions.…”

Predictive Role of hsCRP in Recurrent Stroke Differed According to Severity of Cerebrovascular Disease: Analysis from a Prospective Cohort Study

“…Ischemic stroke and transient ischemic attack (TIA) are characterized by early recurrence, which may be fatal or disabling. The rate of recurrent stroke is reported to be around 10% within 3 months after the index event [ 1 , 2 , 3 ]. Early identification of patients at high-risk of recurrence is of clinical importance.…”

Stroke Recurrence as a Challenge for Countries

“…Using the China National Stroke Registries (CNSRs) for 2007 to 2008 (CNSR I) and 2015 to 2018 (CNSR III), Xu and colleagues systematically assessed changes in the rate of stroke recurrence in a Chinese population and found that cumulative incidence of recurrent stroke within 12 months decreased from 15.5% to 12.5% over 10 years. Interestingly, this outcome was accompanied by the finding that use of secondary preventive medications increased markedly in the past decade in China.…”

“…Based on this finding, the authors hypothesized that there may have been suboptimal control of traditional risk factors or lack of awareness and management of potential new risk factors. To test the hypothesis, Xu and colleagues assessed the risk factor patterns for recurrent stroke by comparing data from CNSR III with those from CNSR I. They found that over the course of 10 years, age, prior stroke, coronary heart disease, higher National Institutes of Health Stroke Scale score, and higher low-density lipoprotein cholesterol (LDL-C) levels remained risk factors associated with stroke recurrence.…”

“…Over the past 2 decades, governments have implemented numerous public education and prevention measures to improve awareness and control of risk factors associated with stroke in China, and this has been associated with increases in awareness and control rates of hypertension by 16.3% and 7.7%, respectively, from 2002 to 2012 . However, the absolute number of stroke survivors in China is increasing rapidly, and therefore the study by Xu et al based on objective data derived from comparable populations is significant and may shed light on an understudied health problem.…”