1
|
Wang XJ. Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery. World J Clin Cases 2025; 13:98048. [PMID: 39866649 PMCID: PMC11577527 DOI: 10.12998/wjcc.v13.i3.98048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 10/11/2024] [Accepted: 10/23/2024] [Indexed: 11/12/2024] Open
Abstract
The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms, and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms, which often make early diagnosis difficult, thus losing the best treatment opportunity. Once cerebral infarction occurs, the consequences are difficult to recover. This is also an important reason for the high misdiagnosis rate and mortality of this disease. In this paper, the characteristics of the disease were analyzed to provide clinical reference.
Collapse
Affiliation(s)
- Xue-Jian Wang
- Department of Neurosurgery, Affiliated Hospital 2 of Nantong University, Nantong 226000, Jiangsu Province, China
| |
Collapse
|
2
|
Huang X, Meng L, Zhao L, Yang S, Lai D, Zhang J, Wu X, Jiang Y, Zhou J, Zhou P, Fu W. Efficacy of acupuncture in patients with carotid atherosclerosis: a randomized controlled clinical trial. BMC Complement Med Ther 2024; 24:313. [PMID: 39174985 PMCID: PMC11340065 DOI: 10.1186/s12906-024-04601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The current clinical management of carotid atherosclerosis is based on the control of risk factors and medicine. However, the risk of adverse events associated with the medicine resulting in concerns and low medication compliance makes it necessary to seek a safer alternative therapy. This study assessed the effectiveness and safety of acupuncture as a treatment for carotid atherosclerosis. METHODS In this randomized controlled trial, patients with carotid atherosclerotic plaques were included and randomly assigned (1:1) to receive real acupuncture or sham acupuncture for 12 weeks. The follow-up period was 12 weeks. The primary outcome included carotid intima-media thickness (cIMT), plaque score (PS), plaque volume (PV) and grey-scale median (GSM). Secondary outcome was pulse wave velocity (PWV). Adverse events results were recorded as safety outcomes. RESULTS From January 2021 to February 2022, 60 eligible patients were included. 55 patients (91.7%) completed the intervention and the 12-week follow-up and there was no statistical difference in demographics between the groups. At the end of treatment, the real acupuncture group had significantly reduced PS (P = 0.002), PV (P = 0.000), and improved GSM (P = 0.044). There was no significant difference in the reduction in cIMT (Left cIMT: P = 0.338, Right cIMT: P = 0.204) and PWV between the groups (the left BS: P = 0.429; the left ES: P = 0.701; the right BS: P = 0.211; the right ES: P = 0.083). Three mild adverse reactions occurred during the study. CONCLUSION This study found that acupuncture had a certain effect on reducing the thickness and volume of carotid plaque and improving the stability of plaque with minor side effects. These findings suggest that acupuncture may be a potential alternative therapy for carotid atherosclerosis. TRIAL REGISTRATION This trial has been registered at ClinicalTrials.gov (ChiCTR2100041762). Submitted 30 December 2020, Registered 4 January 2021 Prospectively registered.
Collapse
Affiliation(s)
- Xichang Huang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lingcui Meng
- Department of Ultrasound Imaging, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Zhao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuang Yang
- Department of Ultrasound Imaging, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Danhui Lai
- Department of Ultrasound Imaging, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianxing Zhang
- Department of Ultrasound Imaging, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoxi Wu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanhui Jiang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhe Zhou
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Peng Zhou
- Shenzhen Ban'an Traditional Chinese Medicine Hospital Group, Shenzhen, 518133, China.
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
- Shenzhen Ban'an Traditional Chinese Medicine Hospital Group, Shenzhen, 518133, China.
- Fu Wenbin Guangdong Province Famous Traditional Chinese Medicine Inheritance Studio, Guangzhou, China.
| |
Collapse
|
3
|
Dženkevičiūtė V, Adomavičius T, Tarutytė G, Rinkūnienė E, Kasiulevičius V, Badarienė J. Carotid Plaques and Hypertension as Risk Factors for Cardiovascular Disease and All-Cause Mortality in Middle-Aged Adults. J Clin Med 2024; 13:2804. [PMID: 38792345 PMCID: PMC11121814 DOI: 10.3390/jcm13102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Both hypertension and carotid atherosclerosis are independent risk factors for cardiovascular disease. We aim to investigate the synergistic effects of hypertension and carotid plaques on cardiovascular events and all-cause mortality. Methods: A follow-up study was conducted at the Preventive Cardiology Department of Vilnius University Hospital Santaros Klinikos between 2012 and 2021. The study recruited participants aged 40-65 who did not have overt cardiovascular disease (CVD) and were part of the Lithuanian High Cardiovascular Risk primary preventive program. The study collected demographic and clinical data, including an ultrasound assessment of carotid plaque. Results: The participants were monitored for 4-10 years for CVD events and all-cause mortality. Among 6138 participants, 954 (16%) experienced CVD events. The presence of carotid plaque on both sides was significantly associated with CVD events, myocardial infarction, and all-cause mortality. However, the combination of hypertension and carotid plaque did not significantly increase the risk for CVD events or all-cause mortality. Conclusions: The risk of CVD events or all-cause mortality was not significantly increased by the combination of hypertension and carotid plaque. Cardiovascular events depend on the extent of atherosclerosis in the carotid arteries.
Collapse
Affiliation(s)
- Vilma Dženkevičiūtė
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Tadas Adomavičius
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Gabrielė Tarutytė
- Department of Research and Innovation, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Egidija Rinkūnienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (E.R.); (J.B.)
| | - Vytautas Kasiulevičius
- Clinic of Internal and Family Medicine, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (T.A.); (V.K.)
| | - Jolita Badarienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (E.R.); (J.B.)
| |
Collapse
|
4
|
Zhu N, Wang Z, Tao M, Li Y, Shen L, Xu T. CircSKA3 is Associated With the Risk of Extracranial Artery Stenosis and Plaque Instability Among Ischemic Stroke Patients. Cell Mol Neurobiol 2024; 44:16. [PMID: 38198062 PMCID: PMC11407158 DOI: 10.1007/s10571-023-01449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Circular RNA circSKA3 (spindle and kinetochore-related complex subunit 3) has been identified as a prognostic factor in ischemic stroke. The objective of this study was to investigate the association of circSKA3 with the risk of extracranial artery stenosis (ECAS) and plaque instability in patients with ischemic stroke. We constructed a competing endogenous RNA (ceRNA) network regulated by circSKA3 based on differentially expressed circRNAs and mRNAs between five patients and five controls. Gene Ontology (GO) analysis was performed on the 65 mRNAs within the network, revealing their primary involvement in inflammatory biological processes. A total of 284 ischemic stroke patients who underwent various imaging examinations were included for further analyses. Each 1 standard deviation increase in the log-transformed blood circSKA3 level was associated with a 56.3% increased risk of ECAS (P = 0.005) and a 142.1% increased risk of plaque instability (P = 0.005). Patients in the top tertile of circSKA3 had a 2.418-fold (P < 0.05) risk of ECAS compared to the reference group (P for trend = 0.02). CircSKA3 demonstrated a significant but limited ability to discriminate the presence of ECAS (AUC = 0.594, P = 0.015) and unstable carotid plaques (AUC = 0.647, P = 0.034). CircSKA3 improved the reclassification power for ECAS (NRI: 9.86%, P = 0.012; IDI: 2.97%, P = 0.007) and plaque instability (NRI: 36.73%, P = 0.008; IDI: 7.05%, P = 0.04) beyond conventional risk factors. CircSKA3 played an important role in the pathogenesis of ischemic stroke by influencing inflammatory biological processes. Increased circSKA3 was positively associated with the risk of ECAS and plaque instability among ischemic stroke patients.
Collapse
Affiliation(s)
- Ning Zhu
- Department of Neurology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Ziyi Wang
- Department of Neurology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Mingfeng Tao
- Department of Neurology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Yongxin Li
- Department of Neurology, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, 226001, China
| | - Lihua Shen
- Department of Neurology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, China
| | - Tian Xu
- Department of Neurology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, 226001, China.
| |
Collapse
|
5
|
Dai P, Yu HX, Wang ZX, Liu SH, Xu GQ. The relationship between severe extracranial artery stenosis or occlusion and cerebral small vessel disease in patients with large artery atherosclerotic cerebral infarction. Front Neurol 2022; 13:1008319. [PMID: 36408498 PMCID: PMC9672318 DOI: 10.3389/fneur.2022.1008319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background and purpose Extracranial artery stenosis (ECAS) is associated with the presence of individual markers of cerebral small vessel disease (CSVD). Here, we investigated the relationship between severe extracranial artery stenosis or occlusion and CSVD in patients with large artery atherosclerotic (LAA) cerebral infarction. Methods A total of 128 patients with LAA cerebral infarction who met our specific inclusion criteria were selected, including 92 males and 36 females. These patients were divided into three groups based on whether they had severe symptomatic extracranial arterial stenosis or occlusion, severe asymptomatic extracranial artery stenosis or occlusion, or severe extracranial artery stenosis or occlusion (both symptomatic and asymptomatic). Intra-group comparisons were then performed to examine whether there were any differences in the total CSVD scores and Fazekas scores. Results Patients with severe extracranial arterial stenosis or occlusion and those with severe asymptomatic extracranial arterial stenosis or occlusion had a significantly higher total CSVD score (P < 0.05), but there were no significant differences between the groups in terms of Fazekas scores. Furthermore, there were no significant difference in the total CSVD scores and Fazekas scores when compared between patients with or without severe symptomatic extracranial arterial stenosis or occlusion. Conclusion Severe stenosis or occlusion of the contralateral extracranial artery may increase the incidence of CSVD in patients with LAA cerebral infarction. Active and effective clinical intervention following comprehensive evaluation should be undertaken for unilateral cerebral infarction patients with severe stenosis or occlusion of the contralateral extracranial arterial.
Collapse
Affiliation(s)
- Pei Dai
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hui-xian Yu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhao-xia Wang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Si-hao Liu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Guang-qing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Guang-qing Xu
| |
Collapse
|
6
|
Syrova I, Kovalenko A, Trubnikova O, Maleva O, Chernobai A, Lozhkin I, Barbarash O. Cerebrovascular complications in patients with moderate and small stenosis of the carotid arteries in the hospital period of coronary artery bypass grafting using cardiopulmonary bypass. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:73-79. [DOI: 10.17116/jnevro202212208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
Nakata T, Okada M, Hanari T, Takagi T, Fujiwara T, Hato N. Association of the prognosis and severity of idiopathic sudden sensorineural hearing loss with cervical ultrasonographic findings. Auris Nasus Larynx 2021; 48:1074-1080. [PMID: 33745790 DOI: 10.1016/j.anl.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association of the prognosis and severity of idiopathic sudden sensorineural hearing loss (ISSNHL) with cervical ultrasonographic findings suggestive of cardiovascular risk. METHODS Seventy-four inpatients with ISSNHL were included in our study. Cervical ultrasonography was performed to evaluate the common carotid artery (CCA), internal carotid artery (ICA), and vertebral artery (VA). The peak systolic velocity, end diastolic velocity, intima-media thickness, pulsatility index (PI), and resistance index (RI) were evaluated. We investigated the relationship of these variables with the severity and prognosis of ISSNHL. RESULTS ICA-PI, ICA-RI, and CCA-RI were significantly higher in patients with poor hearing prognosis than in those with good prognosis. The variables of VA were not related to the prognosis of ISSNHL. There were no statistically significant differences between ISSNHL severity and cervical ultrasonographic findings. CONCLUSIONS We found that PI and RI might be prognostic factors for ISSNHL.
Collapse
Affiliation(s)
- Takahiro Nakata
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon Ehime 791-0295, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon Ehime 791-0295, Japan.
| | - Takahiro Hanari
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon Ehime 791-0295, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon Ehime 791-0295, Japan
| | - Takashi Fujiwara
- Department of Public Health Research, Kurashiki Clinical Research Institute, Kurashiki, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon Ehime 791-0295, Japan
| |
Collapse
|
8
|
Influence of sex and menopausal status on the relationship between metabolic syndrome and coronary artery calcification: a Chinese community-based cross-sectional study. ACTA ACUST UNITED AC 2021; 28:546-553. [PMID: 33625107 DOI: 10.1097/gme.0000000000001750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the association between metabolic syndrome and coronary artery calcification according to different sex and menopausal status. METHODS This cross-sectional study included 2,704 adults from the Jidong community (Tangshan, China) recruited from July 2013 to August 2014. Adults aged ≥40 years with no cardiovascular disease and with coronary artery calcification score data were included. Metabolic syndrome was defined according to the 2005 International Diabetes Federation standard. Coronary artery calcification score was determined using the Agatston method. The associations between metabolic syndrome and coronary artery calcification prevalence were evaluated using logistic regression. RESULTS In the multivariable regression analysis, metabolic syndrome was associated with coronary artery calcification (odds ratio: 1.34, 95% confidence interval: 1.04-1.71, P = 0.021). When stratified by sex, metabolic syndrome was positively associated with coronary artery calcification prevalence in female participants (odds ratio: 2.79, 95% confidence interval: 1.96-3.96, P < 0.001), whereas no association was observed in male participants. Furthermore, metabolic syndrome was associated with a higher prevalence of coronary artery calcification (P < 0.001) independent of adjustment for covariates in postmenopausal women than in premenopausal women, and coronary artery calcification prevalence increased with an increase in conditions related to metabolic syndrome. CONCLUSIONS Our findings indicate that metabolic syndrome in postmenopausal women is associated with a higher prevalence of coronary artery disease than in premenopausal women and men.
Collapse
|
9
|
Zhang Y, Fang X, Guan S, Wu X, Liu H, Wang C, Zhang Z, Gu X, Liu C, Cheng J. Validation of 10-Year Stroke Prediction Scores in a Community-Based Cohort of Chinese Older Adults. Front Neurol 2020; 11:986. [PMID: 33192957 PMCID: PMC7642878 DOI: 10.3389/fneur.2020.00986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55–84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ2-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560–0.644] for men using China-PAR and 0.568 [95% CI: 0.524–0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564–0.639] and 0.575 [95% CI: 0.537–0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.
Collapse
Affiliation(s)
- Yanlei Zhang
- Department of Neurology, the First affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianghua Fang
- Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Wu
- Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongjun Liu
- Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- Geriatric Department, Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Liu
- Geriatric Department, Beijing Geriatric Hospital, Beijing, China
| | - Jianhua Cheng
- Department of Neurology, the First affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
10
|
Lian H, Xu X, Shen X, Chen J, Mao D, Zhao Y, Yao M. Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale. BMC Neurol 2020; 20:272. [PMID: 32641003 PMCID: PMC7341669 DOI: 10.1186/s12883-020-01833-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
Background Cerebral-cardiac syndrome, newly developed cardiac damage manifestations subsequent to cerebral injuries, is a common complication of stroke and leads to increased morbidity and mortality. The current study is aimed to develop a risk prediction scale to stratify high-risk population of CCS among ischemic stroke patients. Methods The study included 410 cases from four tertiary medical centers from June 2018 to April 2019. The risk prediction model was established via logistic regression from the derivation cohort including 250 cases admitted between June 2018 and December 2018. Another 160 cases admitted from January 2019 to April 2019 were included as the validation cohort for external validation. The performance of the model was determined by the area under curve of the receiver operating characteristic curve. A rating scale was developed based on the magnitude of the logistic regression coefficient. Results The prevalence of CCS was 55.2% in our study. The predictive model derived from the derivation cohort showed good calibration by Hosmer-Lemeshow test (P = 0.492), and showed sensitivity of 0.935, specificity of 0.720, and Youden index of 0.655. The C-statistic for derivation and validation cohort were 0.888 and 0.813, respectively. Our PANSCAN score (0 to 10 points) was then established, which consists of the following independent risk factors: PT(12 s–14 s = 0; otherwise = 1), APTT(30s–45s = 0, otherwise = 1), Neutrophils(50–70% = 0; otherwise = 1), Sex(female = 1), Carotid artery stenosis(normal or mild = 0; moderate to severe = 2), Age(≥65 years = 1), NIHSS score(1 to 4 = 2; ≥5 = 3). Patients scored 3 or more points were stratified as high risk. Conclusion The risk prediction model showed satisfactory prediction effects. The PANSCAN scale provides convenient reference for preventative treatment and early management for high-risk patients. Trial registration The study was retrospectively registered in Chinese Trial Registry. The date of registration is April 17, 2019. Trial registration number: ChiCTR1900022587.
Collapse
Affiliation(s)
- Haijuan Lian
- Hangzhou Medical College, Hangzhou, 310053, China.,The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Xiaomeng Xu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, China
| | - Xuhui Shen
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Jinhua Chen
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Dandan Mao
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Yan Zhao
- Medicine & Nursing Science School, Huzhou University, 1 Xueshi Road, Huzhou, 313000, China
| | - Meiqi Yao
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
11
|
Bai X, Feng Y, Li L, Yang K, Wang T, Luo J, Wang X, Ling F, Ma Y, Jiao L. Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e035094. [PMID: 32624471 PMCID: PMC7337893 DOI: 10.1136/bmjopen-2019-035094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Carotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS. METHODS AND ANALYSIS This protocol was designed based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Publication time for studies will be set from 1 January 2000 to 1 June 2020. We will search three databases: PubMed, EMBASE and The Cochrane Library. Suitable randomised controlled studies will be screened. The primary outcomes will include short-term and long-term mortality, stroke and myocardial infarction. OR and HR for dichotomous data and time-to-event data with 95% CIs will be calculated. Treatment effects among different therapies will be ranked according to the surface under the cumulative ranking curve and mean rank. A comprehensive evaluation of the risk of bias, heterogeneity and transitivity will be performed before data synthesis. Consistency and evidence quality will also be assessed. ETHICS AND DISSEMINATION There will be no need for ethics approval as this systematic review is a summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019138942.
Collapse
Affiliation(s)
- Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuanwu Hospital, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
12
|
Sun P, Liu L, Liu C, Zhang Y, Yang Y, Qin X, Li J, Cao J, Zhang Y, Zhou Z, Xu X, Huo Y. Carotid Intima-Media Thickness and the Risk of First Stroke in Patients With Hypertension. Stroke 2020; 51:379-386. [PMID: 31948356 DOI: 10.1161/strokeaha.119.026587] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose—
This study aimed to investigate the association between mean carotid intima-media thickness (cIMT) and the risk of first stroke and examine any possible effect modifiers in patients with hypertension.
Methods—
A total of 11 547 hypertensive participants without history of stroke from the CSPPT (China Stroke Primary Prevention Trial) were included in this analysis. The primary outcome was first stroke.
Results—
Over a median follow-up of 4.4 years, 726 first strokes were identified, of which 631 were ischemic, and 90 were hemorrhagic. A per SD increase in mean cIMT was positively associated with the risk of first stroke (hazard ratio [HR], 1.11 [95% CI, 1.03–1.20]), and first ischemic stroke (HR, 1.10 [95% CI, 1.01–1.20]). Moreover, when cIMT was categorized in quartiles, the higher risks of first stroke (HR, 1.31 [95% CI, 1.06–1.61]) and first hemorrhagic stroke (HR, 2.25 [95% CI, 1.11–4.58]) were found in participants in quartile 2 to 4 (≥0.66 mm), compared with those in quartile 1 (<0.66 mm). More importantly, the cIMT-first stroke association was significantly stronger in participants with higher mean arterial pressure (≥109.3 [quintile 5] versus <109.3 mm Hg,
P
-interaction=0.024) or diastolic blood pressure levels (≥90.7 [quintile 5] versus <90.7 mm Hg,
P
-interaction=0.009).
Conclusions—
There was a significant positive association between baseline cIMT and the risk of first stroke in patients with hypertension. This association was even stronger among those with higher mean arterial pressure or diastolic blood pressure levels.
Collapse
Affiliation(s)
- Pengfei Sun
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | | | - Yan Zhang
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Ying Yang
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y. Zhang)
| | - Jianping Li
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| | - Jingjing Cao
- Institute of Biomedicine, Anhui Medical University, Hefei, China (J.C.)
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China (X.Q., Y. Zhang)
| | - Ziyi Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, China (L.L., Z.Z., X.X.)
| | - Yong Huo
- From the Department of Cardiology, Peking University First Hospital, Beijing, China (P.S., Y. Zhang, Y.Y., J.L., Y.H.)
| |
Collapse
|
13
|
Lee CB, Liao CM, Peng LH, Lin CM. Economic fluctuations and cardiovascular diseases: A multiple-input time series analysis. PLoS One 2019; 14:e0219358. [PMID: 31386665 PMCID: PMC6684041 DOI: 10.1371/journal.pone.0219358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/22/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives Little is known about the gender and age differences associated with the effects of economic fluctuations on hospitalization for cardiovascular diseases. This paper investigates the impact of economic fluctuations on hospitalization for ischemic heart disease (IHD), stroke, and hypertension by age and gender between January 1996 and December 2012 in Taiwan. Methods We adopted a multiple-input time series analysis to examine the strength of the immediate and latent effects of the 17-year quarterly unemployment rates (UR), air pollution exposure (APE), gross domestic product (GDP), per capita consumption expenditure in cigarette and alcohol (ECA), and per capita healthcare expenditure (HE) on the adjusted quarterly incidence rate of hospitalization. The data used in this paper were retrieved from the National Health Insurance Research Database and the website of the Directorate-General of Budget, Accounting and Statistics (DGBAS), Executive Yuan. Results Our findings indicate that higher UR increased IHD hospitalization in young men and women and middle-aged women but reduced stroke hospitalization in young men. Higher APE increased IHD hospitalization in young men but reduced it for young women, increased stroke hospitalization in old men and middle-aged women but reduced it for young men, and increased hypertension hospitalization in middle-aged men and young women. Higher ECA reduced IHD hospitalization in middle-aged men, increased stoke hospitalization in middle-aged and old men and middle-aged women. Higher HE reduced IHD hospitalization in old men, young and old women, reduced stroke hospitalization in old women, and reduced hypertension hospitalization in young and middle-aged women. Conclusions Overall, we found that the economic fluctuations caused increased harmful effects in certain population subgroups but also brought some soothing effects to some groups.
Collapse
Affiliation(s)
- Chiachi Bonnie Lee
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chen-Mao Liao
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan, Taiwan
| | - Li-Hsin Peng
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan, Taiwan
| | - Chih-Ming Lin
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
- * E-mail:
| |
Collapse
|
14
|
Lu T, Liang J, Wei N, Pan L, Yang H, Weng B, Zeng J. Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins. Front Neurol 2019; 10:243. [PMID: 30949118 PMCID: PMC6437037 DOI: 10.3389/fneur.2019.00243] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose: Extracranial artery stenosis (ECAS) is related to individual imaging markers of cerebral small vessel disease (cSVD). However, little has been reported on the association between ECAS and the total burden of cSVD as assessed by magnetic resonance imaging (MRI). The purpose of this study was to investigate the relationship between ECAS and cSVD burden in patients with ischemic stroke of suspected small or large artery origin. Methods: We reviewed consecutive patients with ischemic stroke of suspected small or large artery origin who underwent color Doppler ultrasonography and brain MRI. Bilateral extracranial cerebral arteries including common carotid artery, internal carotid artery (ICA), and proximal vertebral artery (VA, ostium, V2–3 segments) were assessed using color Doppler ultrasonography. ECAS severity was classified as no/mild stenosis, moderate stenosis, severe stenosis, or occlusion. The total cSVD score was assessed by awarding one point according to the load of each of these cSVD markers as determined using MRI; lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces. The relationship between ECAS severity and cSVD burden according to MRI was examined. Results: Two hundred and twenty one patients were included in this study (mean age 61 ± 12 years, 75.6% male). Hypertension, current smoking, hyperlipidaemia, and diabetic mellitus were frequent among the patients (67.4, 45.7, 43.9, and 36.7%, respectively), while the other vascular risk factors including previous stroke or TIA and alcohol excess were less frequent (19.0 and 15.4%, respectively). Patients with higher total cSVD burden was significantly older and had severer ECAS. The frequency of hypertension was significantly higher in patients with higher total cSVD burden. This analysis indicated that that increasing ECAS severity (from no stenosis through to 100%) was independently associated with increasing total cSVD score after adjusting for other vascular risk factors (odds ratio 1.76, 95% CI [1.16–2.69]). Conclusions: In this study, high levels of ECAS from ultrasound evidence were associated with coexisting advanced cerebral cSVD in ischemic stroke patients of suspected small or large artery origin. Further studies are required to determine if and how extracranial arterial imaging helps reduce cSVD burden or improves cognitive function.
Collapse
Affiliation(s)
- Tao Lu
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.,Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiahui Liang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ninglin Wei
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Liya Pan
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Hong Yang
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Baohui Weng
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
15
|
Tan ECL, Tai MLS, Chan WK, Mahadeva S. Association between non-alcoholic fatty liver disease evaluated by transient elastography with extracranial carotid atherosclerosis in a multiethnic Asian community. JGH OPEN 2018; 3:117-125. [PMID: 31061886 PMCID: PMC6487823 DOI: 10.1002/jgh3.12114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/14/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
Background and Aim There is not much data on the association between non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis assessed using Fibroscan with carotid intima‐media thickness (CIMT) in the general population. The objective of this study was to evaluate the association between NAFLD and advanced fibrosis, as diagnosed by Fibroscan, with an increased CIMT in the Malaysian population. Methods A cross‐sectional study of government officers and their family members attending a health screening at a public healthcare facility was conducted. All subjects underwent clinical evaluation, biochemical testing, anthropometry, ultrasound carotid Doppler, and Fibroscan examination. Results Data for 251 subjects were analyzed (mean age 47.1 ± 12.4 years, 74.1% male). Prevalence of NAFLD and advanced fibrosis were 57.4 and 17.5%, respectively. Independent factors associated with NAFLD were waist circumference (odds ratio [OR] = 1.077, 95% confidence interval [CI] 1.038–1.118, P < 0.001) and serum alanine aminotransferase (ALT) (OR = 1.039, 95% CI 1.005–1.074, P = 0.024). Independent factors associated with advanced fibrosis were male gender (OR = 4.847, 95% CI 1.369–17.155, P = 0.014) and serum aspartate aminotransferase (AST) (OR = 1.057, 95% CI 1.003–1.113, P = 0.036). Prevalence of increased CIMT was 29.0%. Independent factor associated with increased CIMT was older age (OR = 1.146, 95% CI 1.067–1.231, P < 0.001). Of the subjects, 34.5% with NAFLD had increased CIMT compared to 19.1% of the subjects without NAFLD (P = 0.063). Advanced fibrosis was not associated with increased CIMT. Conclusions Prevalence of NAFLD, advanced liver fibrosis, and increased CIMT were high. NAFLD and advanced liver fibrosis appeared not to be associated with increased CIMT. However, a larger sample size is needed to demonstrate whether there is any association.
Collapse
Affiliation(s)
- Eugene Choon-Li Tan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine University Malaya Kuala Lumpur Malaysia
| |
Collapse
|
16
|
Ideal Cardiovascular Health Metrics Associated with Reductions in the Risk of Extracranial Carotid Artery Stenosis: a Population-based Cohort Study. Sci Rep 2018; 8:12277. [PMID: 30115933 PMCID: PMC6095842 DOI: 10.1038/s41598-018-29754-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/17/2018] [Indexed: 01/08/2023] Open
Abstract
The cardiovascular health (CVH) metrics are closely related to the risk of stroke. Extracranial carotid artery stenosis (ECAS) represents an important risk factor for ischemic stroke. The present study aims to explore the longitudinal effect of the baseline CVH metrics on the development of ECAS. Totally 5,440 participants were randomly enrolled in the Asymptomatic Polyvascular Abnormalities Community study from 2010 to 2011. Information regarding the seven CVH metrics was collected at baseline. ECAS was assessed by performing carotid duplex sonography at baseline (2010-2011) and during the follow-up (2012-2013). Finally 3,487 subjects were included, and 976 participants developed ECAS during the 2-year follow-up. The optimum CVH status was associated with a 42% (95% confidence interval: 0.40-0.85) decreased risk of the incidence of ECAS after adjusting for age, sex, weight, education, income, alcohol use, waist-hip ratio, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, homocysteine, and C-reactive protein. Ideal physical activity, total cholesterol and fasting blood glucose were independent protective factors of ECAS. In this cohort study, the ideal baseline CVH status was negatively associated with the occurrence of ECAS during the follow-up. This study provides practical insight for further developing effective screening strategies or implementing the best medical treatment.
Collapse
|
17
|
An D, Zhang J, Tang X, Gao P, Li Y, Wang Y, Zhu D. Association of ATP2B1 common variants with asymptomatic intracranial and extracranial large artery stenosis in hypertension patients. Clin Exp Hypertens 2018; 41:323-329. [PMID: 29902063 DOI: 10.1080/10641963.2018.1481421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Genetic factors play an important role in the cervico-cerebral large-artery atherosclerotic stenosis (LAS), and ATP2B1 gene has been associated with the process of atherosclerosis disorders, such as coronary artery disease and arterial stiffness. But there is little information about the relationship between ATP2B1 gene and atherosclerosis in the intracranial arteries. We hereby investigated the association of common variants in ATP2B1 gene with LAS in asymptomatic Chinese hypertension patients. METHODS The stenosis of intracranial and extracranial arteries were evaluated in 899 subjects through computerized tomography angiography from the aortic arch to the skull base. A total of 11 ATP2B1 common variants were genotyped. Multivariate logistic regression was carried out in a dominant model with confounding factors adjusted. RESULTS rs17249754-A (OR = 0.43, p = 0.0002) and rs1401982-G (OR = 0.47, p = 0.0007) were associated with decreased susceptibility of concurrent extra and intracranial stenosis even after Bonferroni correction. These two minor alleles were also significantly associated with less stenotic arteries and moderate-to-severe stenosis. CONCLUSION rs17249754 and rs1401982 were associated with asymptomatic LAS in stroke-free Chinese hypertension patients and might benefit early recognition of LAS patients in clinical practice.
Collapse
Affiliation(s)
- Dewei An
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jin Zhang
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaofeng Tang
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Pingjin Gao
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yan Li
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yan Wang
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Dingliang Zhu
- a Research Center for Hypertension Management and Prevention in Community, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, Shanghai Institute of Hypertension, Ruijin Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| |
Collapse
|
18
|
Wang X, Li W, Song F, Wang L, Fu Q, Cao S, Gan Y, Zhang W, Yue W, Yan F, Shi W, Wang X, Zhang H, Zhang H, Wang Z, Lu Z. Carotid Atherosclerosis Detected by Ultrasonography: A National Cross-Sectional Study. J Am Heart Assoc 2018; 7:JAHA.118.008701. [PMID: 29622590 PMCID: PMC6015437 DOI: 10.1161/jaha.118.008701] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Carotid atherosclerosis (CA) is a reflector of generalized atherosclerosis that is associated with systemic vascular disease. Data are limited on the epidemiology of carotid lesions in a large, nationally representative population sample. We aimed to evaluate the prevalence of CA detected by carotid ultrasonography and related risk factors based on a national survey in China. Methods and Results A total of 107 095 residents aged ≥40 years from the China National Stroke Prevention Project underwent carotid ultrasound examination. Participants with carotid endarterectomy or carotid stenting and those with stroke or coronary heart disease were excluded. Data from 84 880 participants were included in the analysis. CA was defined as increased intima–media thickness (IMT) ≥1 mm or presence of plaques. Of the 84 880 participants, 46.4% were men, and the mean age was 60.7±10.3 years. The standardized prevalence of CA was 36.2% overall, increased with age, and was higher in men than in women. Prevalence of CA was higher among participants living in rural areas than in urban areas. Approximately 26.5% of participants had increased IMT, and 13.9% presented plaques. There was an age‐related increase in participants with increased IMT, plaque presence, and stenosis. In multiple logistic regression analysis, older age, male sex, residence in rural areas, smoking, alcohol consumption, physical inactivity, obesity, hypertension, diabetes mellitus, and dyslipidemia were associated with CA. Conclusions CA was highly prevalent in a middle‐aged and older Chinese population. This result shows the potential clinical importance of focusing on primary prevention of atherosclerosis progression.
Collapse
Affiliation(s)
- Xiaojun Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Fujian Song
- Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, United Kingdom
| | - Longde Wang
- The National Health and Family Commission, Beijing, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College
| | - Shiyi Cao
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital & Medical College
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wenhuan Shi
- Department of Science and Education, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Xiaoli Wang
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Hong Zhang
- Department of Science and Education, People's Hospital of Deyang City, Sichuan, China
| | - Hao Zhang
- Department of Neurology, Rizhao People's Hospital, Rizhao, Shandong, China
| | - Zhihong Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital Shenzhen University, Shenzhen, Guangdong, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College
| |
Collapse
|
19
|
Huang YQ, Huang C, Chen JY, Li J, Feng YQ. Plasma expression level of miRNA let-7 is positively correlated with carotid intima-media thickness in patients with essential hypertension. J Hum Hypertens 2017; 31:843-847. [PMID: 28816229 DOI: 10.1038/jhh.2017.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
MicroRNAs (miRNA, miR) play vital part in the pathophysiology of arterial remodeling in hypertension patients, and are increasingly becoming novel biomarkers in cardiovascular disease. The study was designed to evaluate the correlation between let-7 expression level and subclinical atherosclerosis in untreated patients with newly diagnosed essential hypertension. We assessed 240 participants including 60 healthy volunteers with normal carotid intima-media thickness (nCIMT), 60 healthy volunteers with increased CIMT (iCIMT), 60 hypertension patients with nCIMT and 60 hypertension patients with iCIMT. All patients underwent measurements of CIMT and ambulatory blood pressure (BP) monitoring. The level of let-7 was quantified using real-time reverse transcription polymerase chain reaction. Correlations of let-7 expression with BP parameters and CIMT were assessed using multiple linear regression analysis. We observed the lowest miRNA let-7 expression (21.70±1.45 vs 29.33±2.58 vs 31.50±1.80 vs 35.49±2.33; P<0.001) in healthy controls with nCIMT, followed by healthy controls with iCIMT, then hypertension patients with nCIMT and highest expression in hypertension patients with iCIMT. Let-7 was independently correlated with CIMT(r=0.587, P<0.001), and multiple linear regression analysis showed that let-7 was independently correlated with CIMT (β=0.031, P<0.001). Our findings provide significant evidence that plasma let-7 could represent a non-invasive marker for atherosclerosis in hypertensive patients and herald the emergence of a potential indicator to monitor end-organ damage in hypertension.
Collapse
Affiliation(s)
- Y-Q Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - C Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - J-Y Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - J Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Y-Q Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
20
|
Guo ZL, Xu JL, Lai RK, Wang SS. Vasectomy and cardiovascular disease risk: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7852. [PMID: 28834896 PMCID: PMC5572018 DOI: 10.1097/md.0000000000007852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/05/2017] [Accepted: 07/31/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Even though several studies comparing vasectomy and cardiovascular disease (CVD) risk have been reported, most are small series with conflicting results. However, the extent of the risk is still uncertain. We therefore explored whether an association exists between vasectomy and CVD incidence and mortality. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies published before January 2017. Multivariate adjusted odds ratio (OR) and associated 95% confidence intervals (CIs) and those by subgroups were extracted and pooled using random-effects models. RESULTS Overall, 12 observational studies (2 cross-sectional studies, 4 case-control studies, and 6 retrospective cohort studies) comprising 299,436 participants were identified. There was no statistically significant relationship between vasectomy and CVD risk (OR: 0.90, 95% CI: 0.81-1.00). Moreover, vasectomy was not associated with CVD mortality (OR: 0.90, 95% CI: 0.81-1.00), coronary heart disease (CHD) incidence (OR: 0.94, 95% CI: 0.88-1.01), stroke incidence (OR: 0.90, 95% CI: 0.72-1.13), and myocardial infarction (MI) incidence (OR: 0.95, 95% CI: 0.88-1.02), with no significant publication bias. In subgroup analyses, the findings on the association between vasectomy and CVD risk were consistent. CONCLUSION Our findings suggest that vasectomy is not associated with the excess risk of CVD incidence and mortality. Nevertheless, large-volume, well-designed observational studies, with different ethnic populations, low risk of bias, and adjusted confounding factors, are awaited to confirm and update the findings of this analysis.
Collapse
Affiliation(s)
- Zhen-Lang Guo
- The Second Clinical College, Guangzhou University of Chinese Medicine
| | - Jing-Li Xu
- The Second Clinical College, Guangzhou University of Chinese Medicine
| | | | - Shu-Sheng Wang
- Department of Urology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| |
Collapse
|
21
|
Zhang Y, Fang X, Hua Y, Tang Z, Guan S, Wu X, Liu H, Liu B, Wang C, Zhang Z, Gu X, Hou C, Liu C. Carotid Artery Plaques, Carotid Intima-Media Thickness, and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective, Community-Based Study. Angiology 2017; 69:120-129. [PMID: 28675103 DOI: 10.1177/0003319717716842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We assessed the effect of asymptomatic carotid atherosclerosis (CAS) on the development of cardiovascular diseases (CVDs) in a community-based population aged ≥55 years in China. A total of 1376 residents underwent CAS assessment by ultrasonography in July 2009. New CVD events, including stroke and coronary heart events, were collected at the follow-up survey at the end of 2014. After adjusting for baseline demographic characteristics and traditional CVD risk factors, the risk of CVD in patients with minimal CAS (mean common carotid artery intima-media thickness [CCA-IMT] ≥1 mm and no plaques), nonstenotic plaques (carotid stenosis <50%), and stenotic plaques (carotid stenosis ≥50%) was 0.8 (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.33-1.69), 2.0 (HR: 2.01, 95% CI: 1.24-3.25), and 3.1 (HR: 3.05, 95% CI: 1.62-5.74) times greater, respectively, than that of patients without CAS (CCA-IMT <1 mm and no plaques). Our findings provide direct evidence of the independent predictive value of the severity of asymptomatic CAS for the development of CVD in older Chinese adults.
Collapse
Affiliation(s)
- Yanlei Zhang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianghua Fang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- 2 Department of vascular ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Wu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongjun Liu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- 2 Department of vascular ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- 3 Geriatric department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- 4 Geriatric department, Friendship Hospital, Capital Medical University, Beijing, China
| | - Chengbei Hou
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Liu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|