1
|
Wei CC, Huang YQ, Yu CH. Relationship between longitudinal changes in lipid composition and ischemic stroke among hypertensive patients. World J Clin Cases 2025; 13:95803. [PMID: 39917573 PMCID: PMC11586792 DOI: 10.12998/wjcc.v13.i4.95803] [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: 04/19/2024] [Revised: 09/10/2024] [Accepted: 11/01/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND Dyslipidemia was strongly linked to stroke, however the relationship between dyslipidemia and its components and ischemic stroke remained unexplained. AIM To investigate the link between longitudinal changes in lipid profiles and dyslipidemia and ischemic stroke in a hypertensive population. METHODS Between 2013 and 2014, 6094 hypertension individuals were included in this, and ischemic stroke cases were documented to the end of 2018. Longitudinal changes of lipid were stratified into four groups: (1) Normal was transformed into normal group; (2) Abnormal was transformed into normal group; (3) Normal was transformed into abnormal group; and (4) Abnormal was transformed into abnormal group. To examine the link between longitudinal changes in dyslipidemia along with its components and the risk of ischemic stroke, we utilized multivariate Cox proportional hazards models with hazard ratio (HR) and 95%CI. RESULTS The average age of the participants was 62.32 years ± 13.00 years, with 329 women making up 54.0% of the sample. Over the course of a mean follow-up of 4.8 years, 143 ischemic strokes happened. When normal was transformed into normal group was used as a reference, after full adjustments, the HR for dyslipidemia and ischemic stroke among abnormal was transformed into normal group, normal was transformed into abnormal group and abnormal was transformed into abnormal group were 1.089 (95%CI: 0.598-1.982; P = 0.779), 2.369 (95%CI: 1.424-3.941; P < 0.001) and 1.448 (95%CI: 1.002-2.298; P = 0.047) (P for trend was 0.233), respectively. CONCLUSION In individuals with hypertension, longitudinal shifts from normal to abnormal in dyslipidemia-particularly in total and low-density lipoprotein cholesterol-were significantly associated with the risk of ischemic stroke.
Collapse
Affiliation(s)
- Cheng-Cheng Wei
- Department of Cardiology, Tongxiang First People's Hospital, Tongxiang 314500, Zhejiang Province, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510080, Guangdong Province, China
| | - Cheng-Hong Yu
- Department of Cardiology, Tongxiang First People's Hospital, Tongxiang 314500, Zhejiang Province, China
| |
Collapse
|
2
|
Gong L, Chen S, Yang Y, Hu W, Cai J, Liu S, Zhao Y, Pei L, Ma J, Chen F. Designing machine learning for big data: A study to identify factors that increase the risk of ischemic stroke and prognosis in hypertensive patients. Digit Health 2024; 10:20552076241288833. [PMID: 39386108 PMCID: PMC11462574 DOI: 10.1177/20552076241288833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 09/17/2024] [Indexed: 10/12/2024] Open
Abstract
Background Ischemic stroke (IS) accounts large amount of stroke incidence. The aim of this study was to discover the risk and prognostic factors that affecting the occurrence of IS in hypertensive patients. Method Study data were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. To avoid biased factors selection process, several approaches were studied including logistic regression, elastic net regression, random forest, correlation analysis, and multifactor logistic regression methods. And seven different machine-learning methods are used to construct predictive models. The performance of the developed models was evaluated using AUC (Area Under the Curve), prediction accuracy, precision, recall, F1 score, PPV (Positive Predictive Value) and NPV (Negative Predictive Value). Interaction analysis was conducted to explore potential relationships between influential factors. Results The study included 92,514 hypertensive patients, of which 1746 hypertensive patients experienced IS. The Gradient Boosted Decision Tree (GBDT) model outperformed the other prediction model terms of prediction accuracy and AUC values in both ischemic and prognosis cases. By using the SHapley Additive exPlanations (SHAP), we found that a range of factors and corresponding interactions between factors are important risk factors for IS and its prognosis in hypertensive patients. Conclusion The study identified factors that increase the risk of IS and poor prognosis in hypertensive patients, which may provide guidance for clinical diagnosis and treatment.
Collapse
Affiliation(s)
- Lingmin Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yuhui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Weiwei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jiaxin Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Sitong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yaling Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Leilei Pei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jiaojiao Ma
- Department of Neurology, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
- Department of Radiology, The First Affiliate Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| |
Collapse
|
3
|
Huang P, Yi X. Effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving alteplase intravenous thrombolysis. Int J Immunopathol Pharmacol 2023; 37:3946320231204597. [PMID: 37771034 PMCID: PMC10540570 DOI: 10.1177/03946320231204597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
Objective: To investigate the effect of admission serum glucose on the clinical prognosis of patients with acute ischemic stroke receiving intravenous alteplase thrombolysis. Methods: Patients with acute ischemic stroke who received intravenous alteplase thrombolysis between January 2016 and December 2017 were enrolled. The clinical prognosis was assessed using the modified Rankin Scale (mRs) at 90 days after onset. Univariate and multivariate logistic regression analyses were conducted to investigate whether admission serum glucose was an independent factor in the 90-day prognosis. The predictive value of admission serum glucose for a 90-day poor prognosis was evaluated using receiver operating characteristic (ROC) curves. All patients were divided into two groups based on admission serum glucose levels: high admission serum glucose (above the cut-off value) and low admission serum glucose (below the cut-off value). The 90-day prognosis of patients with different admission serum glucose was analyzed. Results: A total of 138 patients were enrolled, including 79 males (57.24%), with a mean age of (68 ± 12) years and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 9 (6 to 13.75). There were 74 cases (53.62%) in the good prognosis group and 64 cases (46.37%) in the poor prognosis group. The results of the univariate analysis indicated that admission serum glucose in the good prognosis group was significantly lower than that in the poor prognosis group [(7.45 ± 2.31) versus (8.80 ± 3.65), p < .05]. Logistic regression analysis revealed that the admission serum glucose level was an independent risk factor for clinical prognosis at 90 days after onset (OR = 1.24, 95% CI:1.01-1.52). ROC curve analysis showed that the cutoff value of admission serum glucose for predicting poor prognosis 90 days after intravenous thrombolytic therapy with alteplase was 6.77 mmol/l AUC (area under curve) 0.623, 95%CI: 0.53-0.72, sensitivity 68.80%, specificity 52.70%. When compared with the admission serum glucose ≥6.77 mmol/l group (83 cases), the 90-day mRS scores in the admission serum glucose <6.77 mmol/l group (55 cases) were lower [3 (1 to 5) scores versus 1 (0 to 3) scores, Z = 2.89, p < .05]. Conclusions: In patients with acute ischemic stroke receiving intravenous alteplase thrombolytic therapy, a higher admission serum glucose level is an independent predictor of adverse neurological outcomes at 90 days postoperatively.
Collapse
Affiliation(s)
- Pan Huang
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China
| | - Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang, China
| |
Collapse
|
4
|
Association between Plasma Homocysteine Concentrations and the First Ischemic Stroke in Hypertensive Patients with Obstructive Sleep Apnea: A 7-Year Retrospective Cohort Study from China. DISEASE MARKERS 2021; 2021:9953858. [PMID: 34621408 PMCID: PMC8492296 DOI: 10.1155/2021/9953858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022]
Abstract
Purpose This study was aimed at investigating the association between baseline plasma homocysteine (Hcy) concentrations and the risk of the first ischemic stroke (IS) and at investigating any possible influential modifying factors in hypertensive patients with obstructive sleep apnea (OSA). Methods Cox proportional hazards regression was employed to investigate the relationship between plasma Hcy concentration and the first IS. A generalized additive model was applied to determine the nonlinear relationship. In addition, we conducted subgroup analysis. Results A total of 2350 hypertensive patients with OSA without a history of IS were enrolled in this study. At a median follow-up of 7.15 years, we identified 93 cases of the first IS. After adjusting for potential confounding, the findings revealed that plasma Hcy concentration was strongly and positively associated with the occurrence of the first IS (per SD increment; HR = 1.37, 95% CI: 1.30-1.44). A nonlinear relationship was found between plasma Hcy concentration and the risk of developing the first IS with inflection points for plasma Hcy of 5 μmol/L. In stratified analysis, a greater positive correlation was found between baseline plasma Hcy concentrations and new-onset IS in patients with DBP ≥ 90 mmHg (per SD increment; HR = 1.48, 95% CI: 1.33-1.65 vs. <90 mmHg: HR = 1.20, 95% CI: 1.02-1.42; P‐interaction = 0.04) and BMI ≥ 24 and <28 kg/m2 (per SD increment; HR = 1.46, 95% CI: 1.26-1.70 vs. <24 kg/m2: HR = 1.13, 95% CI: 0.95-1.33 vs. ≥28 kg/m2: HR = 1.46, 95% CI: 1.25-1.70; P‐interaction = 0.03). Conclusion Elevated plasma Hcy concentrations are independently associated with the risk of the first IS in hypertensive patients with OSA. Plasma Hcy concentrations ≥ 5 μmol/L surely increased the risk of the first IS in hypertensive patients with OSA.
Collapse
|
5
|
Ran J, Cui Y, Wang Y, Gu P. Relationship between fasting blood glucose and subsequent vascular events in Chinese patients with mild ischaemic stroke: a cohort study. J Int Med Res 2021; 49:3000605211019645. [PMID: 34044643 PMCID: PMC8165852 DOI: 10.1177/03000605211019645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To characterise the relationship between fasting blood glucose (FBG) and the
incidence of subsequent vascular events (SVE) during the 6 months following
a mild ischaemic stroke (MIS) in Chinese patients. Methods Data from patients with MIS were retrospectively analysed. The primary
endpoint was an SVE during the 6-month follow-up period. The participants
were allocated to three groups (tertiles), according to their FBG
concentration. Results Of the 260 participants, 51 (19.6%) reported an SVE during the follow-up
period. The incidence of SVE significantly differed among the tertiles of
FBG. The odds ratio (OR) was 2.361 (95% confidence interval [CI]:
1.551–3.594) for FBG as a continuous variable and that for FBG categorised
according to tertile was 13.30 (95% CI: 3.519–50.322) in the fully adjusted
model. Curve fitting showed that the incidence of SVE gradually increased
with increasing FBG, with the highest tertile showing the highest mean
incidence (46.7%; 95% CI: 16.2%–79.9%). In addition, participants with or
without diabetes mellitus, hypertension, headache, dizziness, mild cognitive
impairment or anterior circulation artery lesion showed similar associations
between FBG and the incidence of SVE. Conclusion FBG is an independent predictor of 6-month SVE risk in Chinese patients with
MIS.
Collapse
Affiliation(s)
- Juanjuan Ran
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Yu Cui
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Yi Wang
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Ping Gu
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| |
Collapse
|