Smoking, Hypertension, and Their Combined Effect on Ischemic Stroke Incidence: A Prospective Study among Inner Mongolians in China

Untargeted metabolomics unravel serum metabolic alterations in smokers with hypertension

Background: Cigarette smoking is an important environmental risk factor for cardiovascular events of hypertension (HTN). Existing studies have provided evidence supporting altered gut microbiota by cigarette smoking, especially in hypertensive patients. Metabolic biomarkers play a central role in the functional potentials of the gut microbiome but are poorly characterized in hypertensive smokers. To explore whether serum metabolomics signatures and compositions of HTN patients were varied in smokers, and investigate their connecting relationship to gut microbiota, the serum metabolites were examined in untreated hypertensive patients using untargeted liquid chromatography-mass spectrometry (LC/MS) analysis. Results: A dramatic difference and clear separation in community features of circulating metabolomics members were seen in smoking HTN patients compared with the non-smoking controls, according to partial least squares discrimination analysis (PLS-DA) and orthogonal partial least squares discrimination analysis (OPLS-DA). Serum metabolic profiles and compositions of smoking patients with HTN were significantly distinct from the controls, and were characterized by enrichment of 12-HETE, 7-Ketodeoxycholic acid, Serotonin, N-Stearoyl tyrosine and Deoxycholic acid glycine conjugate, and the depletion of Tetradecanedioic acid, Hippuric acid, Glyceric acid, 20-Hydroxyeicosatetraenoic acid, Phenylpyruvic acid and Capric acid. Additionally, the metabolome displayed prominent functional signatures, with a majority proportion of the metabolites identified to be discriminating between groups distributed in Starch and sucrose metabolism, Caffeine metabolism, Pyruvate metabolism, Glycine, serine and threonine metabolism, and Phenylalanine metabolic pathways. Furthermore, the observation of alterations in metabolites associated with intestinal microbial taxonomy indicated that these metabolic members might mediate the effects of gut microbiome on the smoking host. Indeed, the metabolites specific to smoking HTNs were strongly organized into co-abundance networks, interacting with an array of clinical parameters, including uric acid (UA), low-denstiy lipoprotein cholesterol (LDLC) and smoking index. Conclusions: In conclusion, we demonstrated disparate circulating blood metabolome composition and functional potentials in hypertensive smokers, showing a linkage between specific metabolites in blood and the gut microbiome.

Risk factors for incident cardiovascular events among adults in low- and middle-income countries: A systematic review and meta-analysis of prospective cohort studies

The relative contributions of risk factors for cardiovascular events at a population level has received little attention in low- and middle-income countries (LMICs). We estimated the population attributable fraction (PAF) of risk factors associated with incident cardiovascular events in LMICs. We searched six databases for relevant articles, supplemented with a manual search of reference lists. Articles included in the meta-analyses were those based on prospective community-based cohorts and incorporating adjusted hazard ratios (HR) or relative risks with 95% confidence intervals (95% CI) for associations between risk factors and a composite cardiovascular and/or stroke endpoint. Pooled HRs and 95% CI were calculated using the random effects model. We assessed heterogeneity using the I² test and study quality using the Newcastle-Ottawa Scale. We calculated the PAF of each associated risk factor. The protocol was registered in PROSPERO (CRD42019122741). We identified 18 cohorts from LMICs with 1,125,846 participants, 77,045 composite cardiovascular events and 42,216 strokes. Substantial proportions of incident cardiovascular events were attributable to hypertension (HR [95% CI], 2.23 [2.01-2.48], PAF = 28%); current smoking (1.44 [1.31-1.58], PAF = 10%); and diabetes mellitus (1.93 [1.67-2.23], PAF = 8%). Other risk factors identified included number of children, depression, bone mineral density, and air pollution. A substantial proportion of incident cardiovascular events were linked to traditional metabolic and behavioural modifiable risk factors. However, other novel risk factors also appear to contribute. Targeting of these established and novel risk factors has the potential to reduce the burden of CVD in LMICs.

A hybrid cost-sensitive machine learning approach for the classification of intelligent disease diagnosis

Automatic risk classification of diseases is one of the most significant health problems in medical and healthcare domain. However, the related studies are relative scarce. In this paper, we design an intelligent diagnosis model based on optimal machine learning algorithms with rich clinical data. First, the disease risk classification problem based on machine learning is defined. Then, the K-means clustering algorithm is used to validate the class label of given data, thereby removing misclassified instances from the original dataset. Furthermore, naive Bayesian algorithm is applied to build the final classifier by using 10-fold cross-validation method. In addition, a novel class-specific attribute weighted approach is adopted to alleviate the conditional independence assumption of naive Bayes, which means we assign each disease attribute a specific weight for each class. Last but not least, a hybrid cost-sensitive disease risk classification model is formulated, and a practical example from the University of California Irvine (UCI) machine learning database is used to illustrate the potential of the proposed method. Experimental results demonstrate that the approach is competitive with the state-of-the-art classifiers.

Knowledge, Prevention Practice and Associated Factors of Stroke Among Hypertensive and Diabetic Patients - A Systematic Review

INTRODUCTION

Because of the inadequate level of public awareness of the disease, the incidence of stroke has been sharply rising. Eventually, due to the prehospital delay, many stroke cases could not be eligible for thrombolysis thereby poor rehabilitative outcome has been tremendously increased. Thus, this study aimed to review the level of knowledge, prevention practice, and associated factors of stroke among hypertensive and diabetic patients.

METHODS

A systematic review of primarily published articles (2010-2020) related to knowledge and prevention practices of stroke was performed by searching online electronic databases like PubMed, Google Scholar, Refseek, Science direct, ResearchGate, and manual Google search by using the keywords and MeSH terms. Studies conducted on knowledge and prevention practices amongst hypertensive and/or diabetic patients were included.

RESULTS

Out of 531 searched studies, 42 articles were identified to be reviewed. The reported overall knowledge of stroke was ranging from 4.4% to 79%. Knowledge to the signs/symptoms of stroke was 23.6% to 87%. However, 15% to 77% of subjects were also reported that they did not know any sign of stroke. The range of risk factor knowledge was 10.5% to 86.6%. The reported level of stroke prevention practice was 2.4% to 72% but physical activity and weight reduction practice were relatively low. Inadequate level of knowledge and prevention practice of stroke was related to elderly, female gender, uneducated, unmarried, rural residents, economically low, comorbidity and unemployed individuals.

CONCLUSION

The current finding revealed that the level of knowledge and prevention practice of stroke was inadequate. Hence, the finding highlights health educational programs should be planned as an important avenue to enhance stroke awareness among the high-risk populations.

Procalcitonin as a prognostic marker of patients with acute ischemic stroke

BACKGROUND

The information on mortality after an acute stroke patient is still limited.

OBJECTIVES

The aim of this study was to investigate the prognostic potential of procalcitonin (PCT) serum levels in acute ischemic stroke.

METHODS

A total of 748 patients were enrolled in this study. Prognostic potential of PCT was evaluated by Kaplan-Meier analysis and multivariable Cox hazard regression analyses.

RESULTS

Procalcitonin levels were found to be significantly higher in acute ischemic stroke patients who died in 30 days than those who survived. Univariate logistic regression analysis showed that PCT was significantly associated with 30-day mortality, and Cox regression analysis revealed that PCT was a strong predictor of 30-day overall mortality. Kaplan-Meier analysis revealed that overall cumulative 30-day mortality was significantly higher in those with PCT levels >1.5 ng/mL when compared to those with PCT levels <1.5 ng/mL.

CONCLUSIONS

Procalcitonin is a significant independent prognostic marker of 30-day mortality after the one set of acute ischemic stroke.

Relationships Between the Cardio-Ankle Vascular Index and Pulsatility Index of the Common Carotid Artery in Patients With Cardiovascular Risk Factors

Background

Pulsatility index (PI) is a hemodynamic parameter determined using Doppler sonography; it reflects the degree of peripheral vascular resistance. Moreover, researchers have reported significant relationships between an increase in the PI of the common carotid artery (CCA) and ischemic stroke. This cross-sectional study aimed to clarify the relationships between cardio-ankle vascular index (CAVI) as a marker of arterial stiffness and the PI of the CCA in patients with cardiovascular risk factors for the primary prevention of ischemic stroke.

Methods

A total of 405 outpatients undergoing treatment for cardiovascular risk factors (152 men and 253 women; mean age ± standard deviation, 64 ± 9 years) with no history of cardiovascular events, including ischemic stroke, were enrolled. The CAVI and the PI of the CCA were measured using commercial devices, and their relationships to various clinical parameters were examined.

Results

A significant positive correlation was observed between the CAVI and the PI of the CCA (r = 0.44, P < 0.001). Further, multiple regression analysis revealed that the CAVI (β = 0.19, P < 0.001) was selected as independent factor for PI of the CCA as a subordinate factor. Meanwhile, high-sensitivity C-reactive protein, as an inflammation marker, and skin autofluorescence, as a marker of advanced glycation end products in the tissues, were selected as independent variables for either the CAVI or the PI of the CCA as a subordinate factor. The receiver-operating characteristic curve analysis indicated that the cut-off point of the CAVI for high PI of the CCA (> 1.60) as a risk value of stroke incidence by previous report was 9.1 (area under the curve = 0.750, P < 0.001).

Conclusion

The present results indicate that the CAVI reflects cerebrovascular resistance in patients with cardiovascular risk factors. Moreover, the risk value of the CAVI for ischemic stroke incidence was considered to be 9.1 in these patients.

Effect of present versus previous smoking on non-invasive haemodynamics

We examined cardiovascular function in 637 volunteers (19-72 years) without antihypertensive medication in never smokers (n = 365), present smokers (n = 81) and previous smokers (n = 191, median abstinence 10 years). Haemodynamics during passive head-up tilt were recorded using whole-body impedance cardiography and radial pulse wave analysis. Results were adjusted for age, sex, body mass index, LDL cholesterol and alcohol use. Systolic and diastolic blood pressure, heart rate, and pulse wave velocity were not different between the groups. Supine aortic reflection times did not differ, while upright values were shorter in present versus previous smokers (p = 0.04). Heart rate adjusted augmentation index was increased in the supine position in present smokers versus controls (p = 0.045), and in present (p < 0.001) and previous (p = 0.031) smokers versus controls in the upright position. Supine and upright cardiac output was higher (p ≤ 0.016) and systemic vascular resistance lower (p ≤ 0.001) in present versus previous smokers. In spite of the long abstinence, in the upright position previous smokers had lower cardiac output (p = 0.032) and higher systemic vascular resistance (p = 0.014) than never smokers. In the absence of differences in blood pressure and arterial stiffness, present smokers presented with hyperdynamic circulation and enhanced wave reflection compared with previous smokers.

Self-reported hypertension in Northern China: a cross-sectional study of a risk prediction model and age trends

BACKGROUND

Hypertension is a major risk factor for the global burden of disease, particularly in countries that are not economically developed. This study aimed to evaluate risk factors associated with self-reported hypertension among residents of Inner Mongolia using a cross-sectional study and to explore trends in the rate of self-reported hypertension.

METHODS

Multi-stage stratified cluster sampling was used to survey 13,554 participants aged more than 15 years residing in Inner Mongolia for the 2013 Fifth Health Service Survey. Hypertension was self-reported based on a past diagnosis of hypertension and current use of antihypertensive medication. Adjusted odds risks (ORs) of self-reported hypertension were derived for each independent risk factor including basic socio-demographic and clinical factors using multivariable logistic regression. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on self-reported hypertension among Inner Mongolia residents.

RESULTS

During study period, self-reported hypertension prevalence was 19.0% (2571/13,554). In multivariable analyses, both female and minority groups were estimated to be associated with increased risk of self-reported hypertension, adjusted ORs (95% CI) were 1.22 (1.08, 1.37) and 1.66 (1.29, 2.13) for other minority compared with Han, increased risk of self-reported hypertension prevalence was associated with age, marital status, drinking, BMI, and comorbidity. In the analyses calculated risk score by regression coefficients, old age (≥71) had a score of 12, which was highest among all examined factors. The predicted probability of self-reported hypertension was positively associated with risk score. Of 13,421 participants with complete data, 284 had a risk score greater than 20, which corresponded to a high estimated probability of self-reported hypertension (≥67%).

CONCLUSIONS

Self-reported hypertension was largely related to multiple clinical and socio-demographic factors. An optimized risk score model can effectively predict self-reported hypertension. Understanding these factors and assessing the risk score model can help to identify the high-risk groups, especially in areas with multi-ethnic populations.