国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

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

第一作者：Jie Xu,Xing Zhang,Aoming Jin

通讯作者：Yongjun Wang

ischemic stroke; stroke recurrence; risk factor pattern

基本信息

2022-06-01

已发表文章

发表杂志：JAMA Network Open

发表类型: Original Contributions

影响因子(IF): 13.353

PMID: 35704318 Pubmed原文链接 全文下载

主要研究背景及目的

From CNSR1 to CNSR3, the 1-year stroke recurrence rate of patients with ischemic stroke has dropped from 17.7% to 9.7%, and the 3-month stroke recurrence rate has dropped from 12.9% to 6.2%, a decrease of nearly 50%. The reason may be due to the use of dual antiplatelet therapy and the control of three major risk factors of blood lipids, blood pressure and blood sugar. However, how to further reduce the current 6.2% risk of stroke recurrence is an urgent problem to be solved. Based on this, we raise three questions: First, whether the three traditional risk factors of blood lipids, blood pressure and blood sugar still contribute to the 6.2% risk of stroke recurrence; second, second, how much does the the non-traditional risk factors (Lpa and inflammatory factors) contribute to the current 6.2 % recurrence risk? Third, if all of the above five risk factors were controlled at target levels, how far can the risk of stroke recurrence be reduced? In order to solve the above three questions, we will use the three national stroke registration databases (CNSR1, CNSR2, and CNSR3) spanning 12 years (from 2007 to 2018) to systematically analyze the sources of the current 6.2% recurrence risk in the realworld of China.

方法

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. 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. MAIN OUTCOMES AND MEASURES The 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 (2015-2018). Logistic regression models were used to evaluate changes in risk factor patterns for stroke recurrence based on data from CNSR I and III.

结论

This study found that stroke recurrence rate in China decreased significantly, but approximately 12.5% of patients still experienced stroke recurrence within 12 months. These findings suggest that more intensive control of traditional risk factors, including LDL-C levels, may be needed to further reduce stroke recurrence.

主要结果

A 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, 1.18-1.31; CNSR III: OR, 1.08; 95% CI, 1.01-1.15), prior stroke (CNSR I: OR, 1.62; 95% CI, 1.45-1.82; CNSR III: OR, 1.66; 95% CI, 1.44-1.92), coronary heart disease (CNSR I: OR, 1.21; 95% CI, 1.04-1.40; CNSR III: OR, 1.23; 95% CI, 1.02-1.49), and LDL-C level per 10 mg/dL (0.259 mmol/L) (CNSR I: OR, 1.02; 95% CI, 1.01-1.04; CNSR III: OR, 1.02; 95% CI, 1.00-1.03), whereas atrial fibrillation (CNSR I: OR, 1.51; 95% CI, 1.26-1.81; CNSR III: OR, 0.95; 95% CI, 0.74-1.23) was no longer an independent risk factor in 2015 to 2018.