Rate and Determinants of Recurrence at 1 Year and 5 Years After Stroke in a Low-Income Population in Rural China

Han, Jing; Mao, Wenjing; Ni, Jingxian; Wu, Yanan; Liu, Jie; Bai, Lingling; Shi, Min; Tu, Jun; Ning, Xianjia; Wang, Jinghua

doi:10.3389/fneur.2020.00002

“…Along these lines, Han Jing et al analyzed stroke recurrence in a rural population and found rates similar to those of the ARTPER study: the recurrent stroke rate was 22.5% at five years [ 11 ]. As in other studies, diabetes was an independent risk factor [ 11 , 24 ]. The ARTPER study looked at urban patients who had easy access to the hospital and primary health center.…”

Section: Discussionsupporting

confidence: 72%

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

Peris

¹

,

Alzamora

²

,

Valverde

³

et al. 2020

JCM

6

0

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Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.

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“…Our findings contradict several studies that have found a history of diabetes as an independent risk factor for an isolated stroke event and stroke recurrence. An HbA1c level ≥6.1% at admission is an independent predictor for stroke recurrence, and the risk of recurrent stroke increases with increasing HbA1c values [21][22][23][24][25]. In this study, we used the casual blood sugar level; however, fasting blood sugar is a better predictor of neurological outcome than casual blood sugar and HbA1c following an acute stroke event [26].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study

Kamgang

¹

,

Tétinou

²

,

Zolo

³

et al. 2021

Neurology Research International

1

13

0

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Introduction. Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods. We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors’ institution as of January 15, 2019. Wilcoxon signed-rank and Fisher’s exact tests were used. Also, a Cox regression model was used to identify confounders.Results. We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out of five had diabetes. Most patients presented with their first stroke event, and a quarter had a stroke recurrence. Stroke recurrence was associated with right handedness (OR = 0.23, 95% CI = 0.16–0.33), congestive heart failure (OR = 3.45, 95% CI = 1.16–10.28), gout (OR = 4.34, 95% CI = 1.09–18.09), dysarthria (OR = 4.34, 95% CI = 1.30–14.54), and facial palsy (OR = 3.96, 95% CII = 1.49 – 10.51), as well as modifiable factors such as elevated abdominal circumference (P < 0.01), systolic blood pressure (P < 0.01), blood glucose level (PI <I 0.01), LDL cholesterol (P < 0.01), and triglyceride levels (P < 0.01). The mulitvariable regression model only identified laterality (B = –1.48, P = 0.04) as a statistically significant explanatory varibale for stroke recurrence. Conclusion. We mapped the landscape of recurrent strokes in Cameroon. There is a need to evaluate the causes of suboptimal drug adherence rates and both the role and adherence to nonpharmacologic interventions.

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“…Recurrent stroke is a frequent complication after stroke. Han et al [7] showed that the overall age-standardized rate of recurrent stroke within one year and five years was 5.7% and 22.5%, respectively. The recurrent stroke could greatly promote the risk of disability and death [7].…”

Section: Introductionmentioning

confidence: 99%

“…Han et al [7] showed that the overall age-standardized rate of recurrent stroke within one year and five years was 5.7% and 22.5%, respectively. The recurrent stroke could greatly promote the risk of disability and death [7]. One study indicated that stroke patients with recurrence events impacted 3 months of unfavorable functional outcomes [8], and another study confirmed that recurrent stroke had been associated with increased mortality and functional dependence [9].…”

Section: Introductionmentioning

confidence: 99%

Serum Interleukin‐37 Increases in Patients after Ischemic Stroke and Is Associated with Stroke Recurrence

Zhang

¹

,

Xu

²

,

Wang

³

et al. 2021

Oxidative Medicine and Cellular Longevity

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Background. This study seeks to assess interleukin-37 (IL-37) serum level in acute ischemic stroke and the value of predicting 3-month stroke recurrence and functional outcome in acute ischemic stroke. Methods. From January 1, 2018, to June 30, 2019, all consecutive first-ever acute ischemic stroke patients from our hospital, China, were included. Serum samples, clinical information, and stroke severity (defined by the National Institute of Health stroke scale (NIHSS) score) were collected at baseline. Serum IL-37 level was measured by the enzyme-linked immunosorbent assay (ELISA) method. Functional impairment (defined by the modified Rankin scale (mRS)) and recurrent stroke were assessed 3 months after admission. The relation of IL-37 with either clinical severity at baseline, unfavorable functional outcome, or stroke recurrence at follow-up was evaluated by logistic regression analysis, and the results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results. Three hundred and ten stroke patients were included. The median IL-37 serum level in those patients was 344.1 pg/ml (interquartile range (IQR), 284.4-405.3 vs. control cases: 122.3 pg/ml (IQR, 104.4-1444.0); P < 0.001 ). At 3 months, a total of 36 (11.6%) patients had a stroke recurrence. IL-37 serum levels in those patients were higher than in those patients without stroke recurrence (417.0 pg/ml (IQR, 359.3-436.1) vs. 333.3 pg/ml (279.0-391.0)). In a logistic model adjusted for other factors, IL-37 in the highest quartile (>405.3 pg/ml) was still associated with recurrent stroke ( OR = 3.32 ; 95 % CI = 2.03 – 6.13 ; P < 0.001 ). IL-37 could promote the NIHSS score (area under the curve (AUC) of the IL-37/NIHSS, 0.75; 95% CI, 0.67–0.83; P < 0.001 ), corresponding to a difference of 0.085 (0.005). Serum IL-37 increases in patients with poor outcome, and an IL-37 in the highest quartile is related to poor outcome ( OR = 4.85 ; 95 % CI = 3.11 − 8.22 ; P < 0.001 ). Conclusion. Serum IL-37 increased in patients after ischemic stroke and was associated with stroke recurrence events and poor stroke outcomes. Large randomized controlled trials should be carried out to confirm whether IL-37 lowering treatment improves stroke prognosis.

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Rate and Determinants of Recurrence at 1 Year and 5 Years After Stroke in a Low-Income Population in Rural China

Cited by 40 publications

References 56 publications

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort

Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study

Serum Interleukin‐37 Increases in Patients after Ischemic Stroke and Is Associated with Stroke Recurrence

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