Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Nontraditional Risk Factors for Residual Recurrence Risk in Patients with Ischemic Stroke of Different Etiologies
First author：Xu Jie，Mo Jinglin
Corresponding author：Wang Yongjun
essential_information
- Person in charge：Xu Jie，Mo Jinglin
- Data Sources： CNSR-Ⅲ
- Number of papers：CNSR-Ⅲ20200168
- Published time：2022-04-07
2022-04-07
Published articles
Journal：Cerebrovascular Diseases
Publication type: Original Contributions
IF(IF): 3.104
PMID: 35390802 Link To Pubmed Full text Download
Background And Purpose
Findings from The United States Preventive Services Task Force study suggested that several nontraditional factors can partly explain the residual risk of cardiovascular disease. However, ischemic stroke is a complication caused by a group of etiologies not only atherosclerosis. Whether the current guideline recommended secondary prevention is effective and the contribution of non-traditional risk factors to residual risk were different among patients with ischemic stroke of different etiologies is unclear. Therefore, our study aims to evaluate the residual risk of stroke recurrence and to identify the determinants of residual risk in patients with various etiologies under persistent standard secondary prevention.
Method
We used 5 evidence-based interventions (antiplatelet therapy, warfarin for atrial fibrillation, antihypertensive therapy, antidiabetic therapy and statins) to document the performance of secondary prevention care of ischemic cerebrovascular event for each patient. The etiology subtypes of ischemic stroke were classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The association between different nontraditional risk factors and stroke outcomes was analyzed using cox regression models. The incremental predictive value of nontraditional risk factors was analyzed by the Harrell c index.
Conclusion
LAA and SAO subtypes own the specific nontraditional risk factors while inflammation is a common risk factor for residual recurrence risk of both.
Main results
In total, 9,733 patients were included in this study. At 3 months, 4,186 (43.0%) patients adhered to 5 secondary prevention strategies, and the residual risk of recurrence was 5.1%. According to Trial of Org 10172 in Acute Stroke Treatment subtypes, cardioembolism benefited the most from current secondary prevention (relative risk reduction: 65.2%), followed by large-artery atherosclerosis (LAA) (29.0%) and small-artery occlusion (SAO) (20.0%). Despite adhering to secondary prevention strategies, high sensitivity C-reactive protein, interleukin-6 (IL-6) levels, and impaired renal function were independent risk factors for the residual recurrence risk of LAA subtype,while IL-6 and trimethylamine N-oxide significantly contributed to the residual risk of SAO subtype.