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Zompola C, Palaiodimou L, Voumvourakis K, Stefanis L, Katsanos AH, Sandset EC, Boviatsis E, Tsivgoulis G. Blood Pressure Variability in Acute Stroke: A Narrative Review. J Clin Med 2024; 13:1981. [PMID: 38610746 PMCID: PMC11012361 DOI: 10.3390/jcm13071981] [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: 03/12/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.
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Affiliation(s)
- Christina Zompola
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, “Aeginition” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON L8L2X2, Canada
| | - Else C. Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, N-0424 Oslo, Norway
| | - Estathios Boviatsis
- Second Department of Neurosurgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Onwuakagba IU, Okoye EC, Kanu FC, Kalu CM, Akaeme DC, Obaji OC, Akosile CO. Population-based stroke risk profile from a West-African community. eNeurologicalSci 2023; 33:100483. [PMID: 38020075 PMCID: PMC10643094 DOI: 10.1016/j.ensci.2023.100483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To determine the stroke risk profile of dwellers of Nnewi community in Nigeria. Methods This was a cross-sectional survey involving consecutively recruited community-dwelling adults without a previous history of stroke. The Modified Framingham Stroke Risk Score (MFSRS) was used to evaluate the stroke risk profile of the participants. Data was analysed using descriptive and inferential statistics at an alpha level of 0.05. Result 310 individuals (mean age = 37.21 ± 15.84 years; 68.7% females) participated in this study. The mean MFSRS (6.79 ± 5.21) of the participants was minimal with 16% having a moderate-to-high risk. Dyslipidaemia (100.0%), meat (88.1%) and sugar (70.6%) consumption, hypertension (37.7%), physical inactivity (43.2%), and psychological stress (41.3%) were the most prevalent risk factors in the population. Participants' MFSRS significantly and positively correlated with their body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) and significantly differed across their gender, educational, and occupational categories (p < 0.05). Conclusion According to MFSRS, the risk of stroke among the sampled community was minimal and was significantly influenced by their BMI, WC, WHR, gender, education, and occupation. However, results revealed that stroke risk might be higher in the population than was depicted by the MFSRS. Enlightenment on the risk of stroke is needed in the community.
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Affiliation(s)
- Ifeoma Uchenna Onwuakagba
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - Emmanuel Chiebuka Okoye
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - Favour Chidera Kanu
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - Chukwuemeka Michael Kalu
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - Daniel Chidubem Akaeme
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | | | - Christopher Olusanjo Akosile
- Department of Medical Rehabilitation, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
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Farashi S, Shahidi S, Sarihi A, Zarei M. Association of vitamin A and its organic compounds with stroke - a systematic review and meta-analysis. Nutr Neurosci 2023; 26:960-974. [PMID: 36004815 DOI: 10.1080/1028415x.2022.2111746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PURPOSE The main purpose of this systematic review was to evaluate the association between the stroke (risk of stroke and the mortality due to stroke) and vitamin A, its organic compounds and its provitamins. METHOD Major databases including PubMed, Scopus, and Web of Science were searched. Studies with human samples were included for risk assessment. The association was assessed using odds ratio (log(OR)) and a random-effect model. I2 statistic, variance (tau2) and prediction interval were used for heterogeneity assessment. The funnel plot was used for publication bias. RESULTS Twenty-one studies including 5789 stroke patients were retrieved. Twenty studies had sufficient information for quantitative analyses. The pooled effect showed an inverse association between vitamin A and its organic compound with the risk of stroke (log(OR) = -0.46 95%CI (-0.81;-0.12)) and with the risk of mortality due to stroke (log(OR) = -0.39 95%CI (-0.74;-0.04)). However, according to subgroup analyses, the association was dependent on the compound in a way that retinol and beta-carotene were the most effective compounds. The effects of several confounding factors and the threshold levels for vitamin A and its organic compound on the effectiveness were discussed. CONCLUSION Insufficiency of retinol and beta-carotene significantly increased the risk of stroke; however, due to heterogeneity between studies more studies are needed for evaluating clinical significance of this outcome.
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Affiliation(s)
- Sajjad Farashi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Siamak Shahidi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdolrahman Sarihi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Zarei
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Physiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Liu X, Ding X, Zhang F, Chen L, Luo Q, Xiao M, Liu X, Wu Y, Tang W, Qiu J, Tang X. Association between alcohol consumption and risk of stroke among adults: results from a prospective cohort study in Chongqing, China. BMC Public Health 2023; 23:1593. [PMID: 37608319 PMCID: PMC10464090 DOI: 10.1186/s12889-023-16361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The incidence of stroke in China is increasing, along with a clear trend in the prevalence of risk factors. Alcohol consumption is also a risk factor for stroke. Many cohort studies have explored the relationship between alcohol consumption and stroke risk. However, findings have been inconsistent. METHODS We used cluster sampling to select 13 districts and counties (at the same level) in Chongqing, China. Then, we used stratified random sampling to distribute the number of people in each district and county. 23,308 adults aged 30-79 were recruited between October 2018 and February 2019. Follow-up was conducted through a monitoring system and questionnaires until September 2022. Information on alcohol consumption and other covariates was collected using a standardized questionnaire. Participants were asked to report their weekly frequency of drinking over the past year and weekly intake of various alcoholic beverages in general. The frequency of drinking was divided into three categories: 1-2 d/week, 3-5 d/week, and 6-7 d/week. The average daily alcohol consumption is calculated based on the amount of alcohol contained in different alcoholic beverages. It is classified as nondrinker (0 g/day), light (0 to 12 g/day), moderate (13 to 36 g/day), and high (> 36 g/day). Cox proportional hazard regression models were used to estimate the association between alcohol consumption and stroke risk. Results are shown as multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS With an average follow-up of 3.80 years, there were 310 new stroke events. The incidence of total stroke was 368.69 per 100,000 person-years. Overall, after adjusting for covariates, moderate alcohol consumption (average daily alcohol consumption 13-36 g/d) was associated with a lower risk of total stroke (HR: 0.48; 95% CI: 0.25-0.92) compared with nondrinkers. The adjusted HR and 95% CI for total stroke and ischemic stroke for those who drank alcohol 6-7 days per week were 0.60(0.37, 0.96) and 0.53(0.30, 0.94), respectively. The risk of total stroke (HR: 0.39; 95% CI: 0.17-0.89) was reduced in a pattern of drinking 6-7 days per week but with a mean alcohol consumption of less than 36 g/d. There was no significant association between alcohol consumption and hemorrhagic stroke. CONCLUSION This study suggests moderate alcohol consumption is associated with a lower risk of total stroke. And healthy drinking patterns should be of more significant concern.
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Affiliation(s)
- Xin Liu
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China
| | - Xianbin Ding
- Institute of Chronic Non-Communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Fan Zhang
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China
| | - Liling Chen
- Institute of Chronic Non-Communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Qinwen Luo
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China
| | - Meng Xiao
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China
| | - Xiang Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Yunyun Wu
- Institute of Chronic Non-Communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Wenge Tang
- Institute of Chronic Non-Communicable Disease Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Jingfu Qiu
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China
| | - Xiaojun Tang
- School of Public Health, Research Center for Medical and Social Development, Chongqing Medical University, Chongqing, China.
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Ayehu GW, Yitbarek GY, Zewdie EA, Amsalu BT, Abie Y, Atlaw D, Agegnehu A, Admasu FT, Azanaw MM, Amare AT, Emiru ZA. Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study. Front Neurol 2022; 13:988677. [DOI: 10.3389/fneur.2022.988677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.MethodsFor this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05.ResultsOf the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.ConclusionAge, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.
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Jin Y, Jiang M, Pan N, Chen Y, Chang W, Zhu L, Fang Z, Fei S, Zhou Z, Zhou S, He L, Yao Y. Influencing factors of stroke occurrence and recurrence in hypertensive patients: A prospective follow-up studies. Brain Behav 2022; 12:e2770. [PMID: 36098663 PMCID: PMC9575602 DOI: 10.1002/brb3.2770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To understand the related risk factors of occurrence and recurrence of hypertension and provide scientific basis for relevant departments to better guide prevention and control work. METHODS From September 2017 to September 2018, a prospective follow-up study was performed on patients with hypertension who visited the Second People's Hospital of Wuhu City, Anhui Province. Multivariate Cox regression was used to analyze influencing factors of stroke occurrence and recurrence in follow-up of hypertensive patients. RESULTS A total of 769 hypertensive patients were enrolled in this study. The average age of hypertensive patients was 65.66 ± 11.70 years old and the BMI index was 24.99 ± 4.17. In this study, 769 patients with hypertension were followed up for 1 year, and the incidence of stroke was 14.69%. This study found that higher levels of blood glucose (RR = 2.027, 95% CI: 1.195-3.438), HCY (RR = 5.928,95% CI: 1.438-24.440), aggravated extent of carotid artery stenosis (RR = 2.620, 95% CI: 1.532-4.481), and drinking (RR = 3.867, 95% CI: 2.038-7.339) were risk factors, and maintaining exercise (RR = 0.325, 95% CI: 0.117-0.907) was a protective factor for stroke occurrence; however, aggravated extent of carotid artery stenosis (RR = 3.158, 95% CI: 1.797-5.550) and smoking (RR = 2.271, 95% CI: 1.142-4.517) were risk factors for stroke recurrence for hypertensive patients. CONCLUSIONS For people with high blood pressure, it is necessary to exercise properly, control body weight, avoid obesity, quit smoking, reduce alcohol consumption, and reasonably control blood pressure, blood sugar, and blood lipid.
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Affiliation(s)
- Yuelong Jin
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Minmin Jiang
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Na Pan
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Yan Chen
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Weiwei Chang
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Lijun Zhu
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Zhengmei Fang
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China
| | - Shizao Fei
- The Second People's Hospital, Wuhu, 241001, Anhui, China
| | - Zixuan Zhou
- School of Medicine, Taizhou University, Jiaojiang, 318000, Zhejiang, China
| | - Siyun Zhou
- School of Medicine, Taizhou University, Jiaojiang, 318000, Zhejiang, China
| | - Lianping He
- School of Medicine, Taizhou University, Jiaojiang, 318000, Zhejiang, China
| | - Yingshui Yao
- School of Public Health, Institute of Chronic Disease Control and Prevention, Wannan Medical College, Wuhu, 241002, Anhui, China.,Anhui College of Traditional Chinese Medicine, Wuhu, 241003, Anhui, China
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7
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Li F, Chen Y, Hong L, Zhu B, Chen D, Qin X, Gao G, Xu J, Cheng X, Dong Q, Jin C, Fang K. Effect of stroke screening survey on intravenous thrombolysis and long-term outcomes in acute ischemic stroke patients: the real-world evidence from Shanghai, China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1363. [PMID: 34733915 PMCID: PMC8506527 DOI: 10.21037/atm-21-1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
Background The stroke screening survey (SSS) is an essential strategy for stroke prevention. However, previous studies rarely discussed the effect of SSS on the acute phase treatment procedure for acute ischemic stroke (AIS) and the long-term prognosis outcomes. This study aims to investigate the effect of SSS on intravenous thrombolysis and long-term outcomes in AIS patients. Methods The stroke patients included were collected from Jiading Residences Community Health Records and Shanghai Stroke Service System database, from January 2017 to December 2019. Patients were divided into two groups, according to whether they have been screened before the event (onset and death). Demographic characteristics and treatment information of patients in the two groups were compared by the Mann-Whitney test and Chi-square test. The demographic differences between groups were adjusted with Propensity Score Matching (PSM) to evaluate the effect of SSS on door-to-needle time (DNT). The Kaplan-Meier survival curve with a log-rank test and multiple Cox regression model were used to evaluate the effect of SSS on long-term lifetime. Results A total of 1,236 patients with AIS were collected, including 468 (37.86%) female, 126 (10.19%) patients with intravenous thrombolysis, 241 (23.30%) patients died from all-cause mortality by January 8, 2020. A total of 124 (10.03%) patients have been screened before AIS onset, and 261 (21.17%) patients had undergone SSS after AIS onset. The baseline information indicated that patients with previous screening were older than the patients without at the time of onset [75 (70, 83) vs. 73 (65, 82), P=0.017], as well as more likely to have a history of hypertension (90.32% vs. 78.51%, P=0.002) and diabetes (50.00% vs. 25.81%, P<0.001). PSM results showed that patients with previous screening were associated with less severe onset situation [3 (1, 9) vs. 3 (1, 5), P=0.001] and shorter DNT [30 (24, 49) vs. 44 (31.5, 49), P=0.037] when compared to patients without. Additionally, patients with SSS had a lower hazard ratio of 0.567 (95% CI: 0.380–0.847, P=0.006) on all-cause mortality. Conclusions For AIS patients, the SSS is associated with less severe onset situation, shorter DNT, and longer long-term lifetime.
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Affiliation(s)
- Fen Li
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Yuqian Chen
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Lan Hong
- Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Bifan Zhu
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Duo Chen
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Xinyu Qin
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Guangfeng Gao
- Jiading Information Center for Health, Shanghai, China
| | - Jianhua Xu
- Department of Neurology, Jiading Central Hospital Affiliated to Shanghai University of Medicine and Health Science, Shanghai, China
| | - Xin Cheng
- Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Stroke Service Center, Shanghai, China
| | - Chunlin Jin
- Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China
| | - Kun Fang
- Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Stroke Service Center, Shanghai, China
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The Effect of Statins on C-Reactive Protein in Stroke Patients: A Systematic Review of Clinical Trials. Mediators Inflamm 2021; 2021:7104934. [PMID: 34489618 PMCID: PMC8418548 DOI: 10.1155/2021/7104934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
Background Statins reportedly have anti-inflammatory effects aside from their lipid-lowering impact. We investigated the effects of statin therapy on the level of C-reactive protein (CRP) or highly sensitive CRP (hs-CRP), a liver-derived marker of systemic inflammation, among stroke patients. Methods An online search was performed in Scopus, PubMed/MEDLINE, ISI Web of Science, and Google Scholar up to November 2020 to recognize clinical trials investigating the effects of statins on the CRP level in stroke patients. Results Overall, nine studies (11 treatment arms) with 1659 participants met the inclusion criteria. Six out of 9 studies (8 out of 11 arms) were categorized as studies with a high-quality methodological approach using the Cochrane Collaboration's tool. Data from 5 treatment arms indicated a significant decrease in CRP concentration, and in one treatment arm, CRP concentration did not suggest any considerable alteration following statin therapy. Moreover, two treatment arms showed a significant reduction in hs-CRP concentration and three treatment arms revealed no significant alteration in hs-CRP concentration following statin therapy. Generally, results were heterogeneous and independent of the type of statin, statin dose, treatment duration, and changes in plasma low-density lipoprotein cholesterol concentration. Conclusion The results suggest that statin therapy could reduce and, therefore, could be considered in these patients as potential anti-inflammatory agents.
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9
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Turana Y, Tengkawan J, Chia YC, Nathaniel M, Wang J, Sukonthasarn A, Chen C, Minh HV, Buranakitjaroen P, Shin J, Siddique S, Nailes JM, Park S, Teo BW, Sison J, Ann Soenarta A, Hoshide S, Tay JC, Prasad Sogunuru G, Zhang Y, Verma N, Wang T, Kario K. Hypertension and stroke in Asia: A comprehensive review from HOPE Asia. J Clin Hypertens (Greenwich) 2021; 23:513-521. [PMID: 33190399 PMCID: PMC8029540 DOI: 10.1111/jch.14099] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
Stroke is the primary cause of disability and vascular death worldwide, including Asia. Asian characteristics that differ from the West lead to higher stroke incidence. Stroke epidemiology studies in Asia have shown varying levels of mortality, incidence, prevalence, and burden of disease. Hypertension is the most prevalent risk factor found in Asia. Besides ethnicity that is associated with stroke incidence, both systolic blood pressure, diastolic blood pressure, and blood pressure variability are positively correlated with stroke incidence. Post-stroke cognitive impairment is one of the sequelae that affect one-third of stroke survivors and has become a significant public health concern that is often neglected despite its increasing prevalence. Therefore, it is very important to prevent recurrence by treating stroke optimally and effectively. Increasing awareness and treatment adherence to hypertension, the leading risk factor for stroke, became the main goal in several countries in Asia.
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Affiliation(s)
- Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Jeslyn Tengkawan
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Yook Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Michael Nathaniel
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Chen‐Huan Chen
- Department of MedicineFaculty of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Huynh Van Minh
- Department of CardiologyHue University HospitalHue UniversityHue CityVietnam
| | - Peera Buranakitjaroen
- Division of HypertensionDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | | | - Jennifer M. Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
- Division of NephrologyDepartment of MedicineNational University Health SystemSingapore CitySingapore
| | - Jorge Sison
- Section of CardiologyDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversity of Indonesia‐National Cardiovascular CenterHarapan KitaJakartaIndonesia
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Yuqing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Narsingh Verma
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Cardiovascular Center and Division of CardiologyDepartment of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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Arayeshgari M, Tapak L, Roshanaei G, Poorolajal J, Ghaleiha A. Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students. BMC Psychiatry 2020; 20:198. [PMID: 32366242 PMCID: PMC7199302 DOI: 10.1186/s12888-020-02591-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD). METHODS A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05). RESULTS The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05). CONCLUSIONS Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.
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Affiliation(s)
- Mahya Arayeshgari
- grid.411950.80000 0004 0611 9280Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. .,Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Ghodratollah Roshanaei
- grid.411950.80000 0004 0611 9280Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran ,grid.411950.80000 0004 0611 9280Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- grid.411950.80000 0004 0611 9280Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran ,grid.411950.80000 0004 0611 9280Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Ghaleiha
- grid.411950.80000 0004 0611 9280Department of Psychiatry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran ,grid.411950.80000 0004 0611 9280Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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