Association of total pre-existing comorbidities with stroke risk: a large-scale community-based cohort study from China

Abstract

Background Comorbidities, any other coexisting diseases in patients with a particular index disease, are known to increase the mortality of a stroke. However, the association of pre-existing comorbidities with stroke risk has not been fully studied. Methods This study included 16,246 adults from a prospective community-based cohort with a baseline survey conducted in 2013 in China. Participants were followed up with hospitalization records and the Cause of Death Registry. The association of eight pre-existing comorbidities (coronary heart disease, hyperlipidemia, hypertension, diabetes, previous stroke, chronic obstructive pulmonary disease, nephropathy, and cancer) with stroke risk was analyzed using the Cox proportional hazard model in 2020. Results At a median follow-up of 5.5 years, a total of 449 participants (206 men and 243 women) developed a stroke. Four pre-existing comorbidities (hypertension, congenital heart disease, previous stroke, and diabetes) were independently and positively associated with the risk for all types of stroke. The adjusted hazard ratios for participants with only 1 and ≥ 2 pre-existing comorbidities compared with those without pre-existing conditions were 1.96 (95% CI: 1.44, 2.67; P < 0.001) and 2.87 (95% CI; 2.09, 3.94; P < 0.001) for total stroke, respectively. Moreover, male and female participants with a combination of increased age and a higher number of pre-existing comorbidities experienced the greatest risk of stroke. Conclusions The number of pre-existing comorbidities was independently associated with an increased risk of stroke. There was a synergic effect between increased age and a higher number of pre-existing comorbidities on stroke occurrence. Our novel findings emphasize the importance and potential application of pre-existing comorbidities as a risk indicator in stroke prevention.

Is the National Institute of Health Stroke Scale a valid prognosticator of the aftermath in patients with ischemic stroke?

“…[ 22 ] Another study reported that DM, hypertension, previous stroke, and heart disease were all significantly and positively linked to the mortalityof stroke. [ 23 ] In the present study, anterior circulator stroke was the commonest type of stroke in survivors as well as non-survivors. Studies have shown that patients with extensive infarcts involvingthe middle cerebral artery have been found to have a mortality rate of up to 78%.…”

Associations of plasma TMAO and its precursors with stroke risk in the general population: A nested case‐control study

“…Hypertension was defined as mean systolic/diastolic blood pressure ≥140/90 mm Hg or use of antihypertensive medications [31]. Participants were considered to have diabetes if they reported a personal history of diabetes, used hypoglycemic drugs, or possessed a fasting blood glucose level of ≥7.0 mmol/L [24]. Hyperlipidemia was determined if participants responded “yes” to the question “Has a doctor ever told you that you suffered from hyperlipidemia?”, self‐reported history of lipid‐lowering treatment, or laboratory measurement (TC >6.20 mmol/L, TG >2.30 mmol/L, or HDL‐C <1.00 mmol/L).…”

“…The details for recruitment, study design, and other characteristics of the Prospective Follow-up Study on Cardiovascular Morbidity and Mortality in China have been previously described [23][24][25]. Briefly, the baseline survey was launched in 2013 in Changshu, Eastern China, and eligible participants aged 35-74 years were included.…”

“…The within-day coefficients of variation (CV) and between-day CV for the assays were 2.3%-11.9% and 4.9%-15.2%, respectively. Plasma glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and creatinine were also determined [23,24]. The calculation of the estimated glomerular filtration rate (eGFR) was referred to the Chronic Kidney Disease Epidemiology Collaboration equation [29].…”

Associations between diagnosis with stroke, comorbidities, and activity of daily living among older adults in the United States

“…As these risk factors accumulate with age, the elders are more likely to have a stroke 11 . It is shown that the number of comorbidities is independently associated with higher stroke occurrence and the combination of older age and more comorbidities leads to a higher risk of stroke 10 . Meanwhile, comorbidities imply more pharmacological treatment and lead to a higher risk of adverse events, therefore a worse stroke prognosis 12,13 .…”