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Mondal MBA, Hasan ATMH, Khan N, Mohammad QD. Prevalence and risk factors of stroke in Bangladesh: A nationwide population-based survey. eNeurologicalSci 2022; 28:100414. [PMID: 35769921 PMCID: PMC9234580 DOI: 10.1016/j.ensci.2022.100414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background A paucity of high-quality epidemiological survey on stroke in Bangladesh emphasizes the need for a drastic effort at the national level to study the burden of stroke in Bangladesh. Therefore, this community survey was conducted with to estimate the prevalence of stroke and its associated common risk factors among Bangladeshi population. Methods This was a population-based cross-sectional study, carried out in 8 administrative divisions and 64 districts to estimate the prevalence of stroke throughout the country. The study adopted a two-stage cluster random sampling approach. The calculated sample size was 25,287. A semi-structured questionnaire was used to identify suspected stroke patients who were subsequently confirmed by consultant neurologists. Result In the first stage, a total number of 25,287 respondents were interviewed throughout the country. Interviewers identified 561 respondents as suspected stroke through the Questionnaire for Verifying Stroke Free Status (QVSFS) system in 64 districts. Of the 25,287 respondents 13,878 (54.9%) were male and 11,409 (45.1%) were female. Mean age was 39.9 years. In the second stage, all suspected stroke cases (561) were further examined by neurologists and finally 288 patients were confirmed as stroke which provided a prevalence of 11.39 per 1000 population. The highest stroke prevalence (14.71 per thousand) were found in Mymensingh division and lowest (7.62 per thousand) found in Rajshahi division. The stroke prevalence varied in different age groups. It was 30.10 per thousand in the age group of >60 years and 4.60 in the age group below 40 years. The prevalence of stroke among male was twice that of female (13.62 versus 8.68 per thousand). The prevalence was slightly higher in rural areas (11.85 versus 11.07). About 50.4% respondents had some idea about stroke. Out of a total of 288 cases, 79.7% (213) patients had an ischemic stroke, 15.7% (42) had hemorrhagic, and 4.6% (12) were diagnosed as subarachnoid hemorrhage. The majority of the stroke patients had hypertension (79.2%), followed by dyslipidemia (38.9%), tobacco use in any form (37.2%), diabetes (28.8%), ischemic heart disease (20.1%). Conclusion We have found a stroke prevalence of 11.39 per 1000 population, the highest being in the Mymensingh division. The prevalence was much higher in the elderly and male population. More than three fourth had an ischemic stroke. Hypertension, dyslipidemia, tobacco use, diabetes, ischemic heart disease are the most common risk factors observed among stroke patients. New FindingsThis is the first-ever nationwide survey in Bangladesh that revealed a stroke prevalence of 11.39 per thousand. There was a wide regional variation in stroke prevalence. The prevalence was twice among males.
Impact of the study resultThe study result will help the policymakers in deciding and planning regional policy guidelines to tackle the stroke burden. It will also help the clinicians to identify common risk factors among stroke patients and take precautionary measures
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Affiliation(s)
| | - A T M Hasibul Hasan
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
| | | | - Quazi Deen Mohammad
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
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Chen J, Zhu Q, Yu L, Li Y, Jia S, Zhang J. Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084807. [PMID: 35457673 PMCID: PMC9030671 DOI: 10.3390/ijerph19084807] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.
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Affiliation(s)
- Jingyi Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Qianrang Zhu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Lianlong Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Shandong Center for Disease Control and Prevention, Ji’nan 250000, China
| | - Yuqian Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Shanshan Jia
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Correspondence: ; Tel.: +86-010-6623-7147
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Wang N, Liu Q, Liu H, Cong X, Yang H, Yu Y, Cao Y, Ma L. Association of Apolipoprotein E Polymorphisms and Risks of Ischemic Stroke in Chinese Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2021; 2021:8816996. [PMID: 33490286 PMCID: PMC7801050 DOI: 10.1155/2021/8816996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/05/2020] [Accepted: 12/24/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The apolipoprotein E (APOE) gene polymorphisms have been intensively studied in patients with type 2 diabetes mellitus (T2DM) and ischemic stroke (IS) in recent years. However, it is unclear whether APOE gene polymorphisms are correlated with increased risk for developing IS in T2DM patients. Thus, this study was designed to examine the association between APOE gene polymorphisms and risks of IS in Chinese patients with T2DM. METHODS This case-control study enrolled 243 subjects with T2DM as controls, and 210 subjects with T2DM complicated with IS as case patients. The genotypes were determined using real-time PCR while HbA1c and lipid levels were detected using commercially available kits. RESULTS The systolic blood pressure (SBP), diastolic blood pressure (DBP), and the proportion of patients with a history of hypertension were higher in the case patients than that in the controls. We confirmed that the ε2/ε3 genotype, as well as SBP and history of hypertension, was the independent risk factor for developing IS in T2DM patients. CONCLUSIONS We conclude that the ε2/ε3 genotype might contribute to the increased risk for developing IS in Chinese patients with T2DM.
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Affiliation(s)
- Na Wang
- Department of Transfusion Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qian Liu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hui Liu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiao Cong
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Hui Yang
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yang Yu
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yongtong Cao
- Department of Transfusion Medicine, China-Japan Friendship Hospital, Beijing 100029, China
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liang Ma
- Clinical Laboratory, China-Japan Friendship Hospital, Beijing 100029, China
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Shi R, Zhang T, Sun H, Hu F. Establishment of Clinical Prediction Model Based on the Study of Risk Factors of Stroke in Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2020; 11:559. [PMID: 32982965 PMCID: PMC7479835 DOI: 10.3389/fendo.2020.00559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Stroke has sparked global concern as it seriously threatens people's life, bringing about dramatic health burdens on patients, especially for type 2 diabetes mellitus (T2DM) patients. Therefore, a risk scoring model is urgently valuable for T2DM patients to predict the risk of stroke incidence and for positive health intervention. Methods: We randomly divided 4,335 T2DM patients into two groups, training set (n = 3,252) and validation set (n = 1,083), at the ratio of 3:1. Characteristic variables were then selected based on the data of training set through least absolute shrinkage and selection operator regression. Three models were established to verify predictive ability. Foundation model was composed of basic information and physical indicators. Biochemical model consisted of biochemical indexes. Integrated model combined the above two models. Data of three models were then put into logistic regression analysis to form nomogram prediction models. Tools including C index, calibration plot, and curve analysis were implemented to test discrimination, calibration, and clinical use. To select the best predicting model, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were put into effect. Results: Eleven risk factors were determined, including age, duration of T2DM, estimated glomerular filtration rate, systolic blood pressure, diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, triglyceride, body mass index, uric acid, and glycosylated hemoglobin A1c, all with significant P-values through logistic regression analysis. In the training set, areas under the curve of three models were 0.810, 0.819, and 0.884, whereas in the validation set, they were 0.836, 0.832, and 0.909. Through calibration plot, the S:P values in the training set were 0.836, 0.754, and 0.621 and were 0.918, 0.682, and 0.666 separately in the validation set. In terms of the decision curve analysis, the risk thresholds were, respectively, 8-73%, 8-98%, and 8%~ in the training set and 8-70%, 8-90%, and 8-95% in the validation set. With the aid of NRI and IDI, integrated model is proved to be the best model in training set and validation set. Besides, internal validation was conducted on all the subjects in this study, and the C index was 0.890 (0.873-0.907). Conclusion: This study established a model predicting risk of stroke for T2DM patients through a community-based survey.
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Ma L, Su H, Wang Y, Zhou Y, Kang Z, Xu Y, Gao J. Interleukin-1β (IL-1β) C-511T polymorphism is associated with susceptibility to coronary artery disease in type 2 diabetic patients. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220918047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Variants of the interleukin-1β (IL-1β) gene have been associated with type 2 diabetes (T2D) and coronary artery diseases (CAD). However, association of IL-1β polymorphisms with diabetic patients having CAD clinical manifestation has not been studied yet. In this study, we aim to decipher the role of IL-1β common promoter variants with susceptibility/resistance to development of CAD in T2D patients. T2D patients with (n = 134) or without CAD (n = 533) were enrolled. A total of 513 essentially healthy individuals from the same population were included in this study as control. Plasma levels of IL-1β were quantified by enzyme-linked immunosorbent assay (ELISA) kit as per instructions from the manufacturer. IL-1β promoter variants (T-31C and C-511T) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). T2D patients displayed higher level of plasma IL-1β in comparison to healthy controls. Prevalence of variants for IL-1β (C-511T) polymorphism was higher in diabetic patients compared to controls (CT: P < 0.0001, OR = 3.01; TT: P < 0.0001, OR = 2.45). IL-1β (C-511T) polymorphism was linked with plasma IL-1β levels. Interestingly, heterozygous mutants (CT) were most prevalent in T2D individuals with CAD compared to those without CAD ( P = 0.03, OR = 1.82). Furthermore, low-density lipoprotein (LDL) and triglycerides were elevated in T2D patients with CAD than in patients without heart-related disorder. No significant association of other polymorphism (T-31C) was noticed with susceptibility to T2D or diabetic patients with heart disorders. IL-1β (C-511T) variants are associated with elevated plasma IL-1β levels. Mutation at the IL-1β promoter region (C-511T) predisposed subjects to the development of T2D and CAD manifestation in diabetic patients.
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Affiliation(s)
- Lijing Ma
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Heng Su
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yan Wang
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yikun Zhou
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhuang Kang
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Ying Xu
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jie Gao
- Department of Endocrinology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
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Lyu Y, Luo Y, Li C, Guo X, Lu J, Wu H, Huo X, Gu W, Yang G, Ji L, Yang X. Regional Differences in the Prevalence of Coronary Heart Disease and Stroke in Patients With Type 2 Diabetes in China. J Clin Endocrinol Metab 2018; 103:3319-3330. [PMID: 29982638 DOI: 10.1210/jc.2018-00422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are large regional variations in the prevalence and mortality of cardiovascular disease in general populations in China. It remains uncertain whether the prevalence in type 2 diabetes mellitus (T2DM) varies by region in China. METHODS We analyzed data of 219,522 Chinese patients with T2DM retrieved from the China National HbA1c Surveillance System in 2012. We used the Chinese population distribution in 2010 to standardize prevalence of coronary heart disease (CHD), stroke, and composite of both in 30 provinces and seven geological regions. Multivariable logistic regression was performed to obtain ORs and CIs of provinces/geological regions for CHD, stroke, and composite of both. RESULTS Age and sex standardized prevalence of CHD, stroke, and composite of both was, respectively, 4.59% (95% CI, 4.58 to 4.60), 1.79% (1.79 to 1.80), and 5.85% (5.84 to 5.86), in contrast to 0.60% of CHD, 0.80% of stroke, and 1.37% of composite of both in the general population in China. After adjustment for traditional risk factors, Northeast had the highest risks of CHD, stroke, and composite of both, and North had the second highest risks of CHD, stroke, and composite of both among the seven regions, both being higher than any other regions (all P values < 0.05). The ORs of Northeast vs Southwest were up to 2.60 (2.35 to 2.88) for CHD, 2.49 (2.15 to 2.88) for stroke, and 2.61 (2.38 to 2.86) for composite of both. CONCLUSIONS There were large variations in risks of CHD, stroke, and composite of both in T2DM in China with Northeast and North having the highest risks.
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Affiliation(s)
- Yuanjun Lyu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Department of Endocrinology, Tianjin Hospital, Tianjin, China
| | - Yingying Luo
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Juming Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Honghua Wu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Xiaoxu Huo
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Weijun Gu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Guoqing Yang
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Abstract
Background Whether metformin use may reduce hypertension risk has not been studied. This study investigated such possibility in patients with type 2 diabetes mellitus. Methods and Results Newly diagnosed patients with type 2 diabetes mellitus during 1999–2005 were enrolled from the reimbursement database of the Taiwan's National Health Insurance and followed to December 31, 2011. Hypertension was defined either by a diagnosis or by a diagnosis plus the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers and/or calcium channel blockers. Analyses were conducted in a propensity score matched‐pair cohort of 4810 ever users and 4810 never users. Cox proportional hazards regression model was used to estimate the hazard ratios. Results showed that when hypertension was defined by a diagnosis, 2261 never users and 1908 ever users developed hypertension. The overall hazard ratio was 0.724 (0.681–0.769) and the hazard ratios for the first (<2.0 months), second (2.0–13.0 months) and third (>13.0 months) tertiles of cumulative duration were 0.820 (0.745–0.903), 0.692 (0.634–0.756), and 0.687 (0.630–0.749), respectively. When cumulative duration of metformin therapy was treated as a continuous variable, the hazard ratio was 0.991 (0.989–0.994) for every 1‐month increment of metformin use. When hypertension was defined by a diagnosis plus the use of antihypertensive drugs, the overall hazard ratio was 0.831 (0.771–0.895), the hazard ratios for the respective tertiles were 0.868 (0.769–0.980), 0.852 (0.767–0.946), and 0.787 (0.709–0.874), and the hazard ratio was 0.994 (0.991–0.997) for every 1‐month increment of metformin use. Conclusions A reduced risk of hypertension is observed in metformin users in a dose‐response pattern.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan .,Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan
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Gan Y, Wu J, Zhang S, Li L, Yin X, Gong Y, Herath C, Mkandawire N, Zhou Y, Song X, Zeng X, Li W, Liu Q, Shu C, Wang Z, Lu Z. Prevalence and risk factors associated with stroke in middle-aged and older Chinese: A community-based cross-sectional study. Sci Rep 2017; 7:9501. [PMID: 28842623 PMCID: PMC5572736 DOI: 10.1038/s41598-017-09849-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 08/01/2017] [Indexed: 11/09/2022] Open
Abstract
Although the prevalence of stroke and its risk factors has been widely reported in some Western countries, information on essential stroke parameters is lacking in China, the most populous nation. A community-based cross-sectional study with 8,018 Chinese adults aged ≥40 years was used to determine the prevalence of stroke and associated risk factors. Within the screened population, the prevalence of stroke was 2.21% for both sexes, 1.60% for females, and 3.18% for males. Prevalence increased with age in both sexes (P < 0.0001). In a multivariable model, factors significantly associated with stroke were increasing age (odds ratio [OR] = 1.87, 95% CI: 1.58-2.24), male gender (OR = 2.03, 95% CI: 1.42-2.90), family history of stroke (OR = 4.33, 95% CI: 2.89-6.49), history of hyperlipidemia (OR = 1.87, 95% CI 1.31-2.68), history of hypertension (OR = 1.47, 95% CI 1.02-2.12), and physical inactivity (OR = 1.74, 95% CI: 1.16-2.59). The findings indicate that stroke prevalence in middle-aged and older Chinese adults is higher in males than in females, and increases with age in both sexes. Population-based public health intervention programs and policies targeting hyperlipidemia and hypertension control and encouragement of physical activity should be highly prioritized for middle-aged and older adults in Shenzhen, China.
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Affiliation(s)
- Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiang Wu
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Shengchao Zhang
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Liqing Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Management, School of Economics and Management, Jiangxi Science and Technology Normal University, Nanchang, Jiangxi, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chulani Herath
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Naomie Mkandawire
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanfeng Zhou
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xingyue Song
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaozhou Zeng
- Bao'an Central Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiaoyan Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 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, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Al-Rubeaan K, Al-Hussain F, Youssef AM, Subhani SN, Al-Sharqawi AH, Ibrahim HM. Ischemic Stroke and Its Risk Factors in a Registry-Based Large Cross-Sectional Diabetic Cohort in a Country Facing a Diabetes Epidemic. J Diabetes Res 2016; 2016:4132589. [PMID: 26989695 PMCID: PMC4771899 DOI: 10.1155/2016/4132589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 11/25/2022] Open
Abstract
The main aim of this study is to determine the prevalence and risk factors of ischemic stroke among diabetic patients registered in the Saudi National Diabetes Registry (SNDR) database. A cross-sectional sample of 62,681 diabetic patients aged ≥25 years was used to calculate ischemic stroke prevalence and its risk factors. Univariate and multivariate logistic regression analyses were used to assess the roles of different risk factors. The prevalence of ischemic stroke was 4.42% and was higher in the older age group with longer diabetes duration. Poor glycemic control and the presence of chronic diabetes complications were associated with a high risk of ischemic stroke. History of smoking and type 2 diabetes were more frequent among stroke patients. Obesity significantly decreased the risk for ischemic stroke. Regression analysis for ischemic stroke risk factors proved that age ≥45 years, male gender, hypertension, coronary artery disease (CAD), diabetes duration ≥10 years, insulin use, and hyperlipidemia were significant independent risk factors for ischemic stroke. We conclude that ischemic stroke is prevalent among diabetic individuals, particularly among those with type 2 diabetes. Good glycemic, hypertension, and hyperlipidemia control, in addition to smoking cessation, are the cornerstones to achieve a significant reduction in ischemic stroke risk.
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Affiliation(s)
- Khalid Al-Rubeaan
- University Diabetes Center, College of Medicine, King Saud University, P.O. Box 18397, Riyadh 11415, Saudi Arabia
- *Khalid Al-Rubeaan:
| | - Fawaz Al-Hussain
- Department of Medicine, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461, Saudi Arabia
| | - Amira M. Youssef
- Registry Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Shazia N. Subhani
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, P.O. Box 3345, Riyadh 11211, Saudi Arabia
| | - Ahmad H. Al-Sharqawi
- Biostatistics Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
| | - Heba M. Ibrahim
- Registry Department, University Diabetes Center, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia
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How CB, Ai-Theng C, Ahmad Z, Ismail M. Men suffer more complications from diabetes than women despite similar glycaemic control and a better cardiovascular risk profile: the ADCM study 2008. JOURNAL OF MENS HEALTH 2012. [DOI: 10.1016/j.jomh.2012.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Rhee SY, Chon S, Kwon MK, Park IB, Ahn KJ, Kim IJ, Kim SH, Lee HW, Koh KS, Kim DM, Baik SH, Lee KW, Nam MS, Park YS, Woo JT, Kim YS. Prevalence of chronic complications in korean patients with type 2 diabetes mellitus based on the korean national diabetes program. Diabetes Metab J 2011; 35:504-12. [PMID: 22111042 PMCID: PMC3221026 DOI: 10.4093/dmj.2011.35.5.504] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 03/30/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The Korean National Diabetes Program (KNDP) cohort study is performing an ongoing large-scale prospective multicenter investigation to discover the pathogenesis of type 2 diabetes in Korean patients. This study was performed to examine the prevalence of chronic complications in patients with type 2 diabetes among those registered in the KNDP cohort within the past 4 years. METHODS This study was performed between June 2006 and September 2009 at 13 university hospitals and included 4,265 KNDP cohort participants. Among the participants, the crude prevalence of microvascular and macrovascular diseases of those checked for diabetes-related complications was determined, and the adjusted standard prevalence and standardization of the general population prevalence ratio (SPR) was estimated based on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) population demographics. RESULTS Among the KNDP registrants, 43.2% had hypertension, 34.8% had dyslipidemia, 10.8% had macrovascular disease, and 16.7% had microvascular disease. The SPR of the KNDP registrants was significantly higher than that of the KNHANES subjects after adjusting for demographics in the KNHANES 2005 population. However, with the exception of cardiovascular disease in females, the standardized prevalence for the most complicated items in the survey was significantly higher than that in the KNHANES subjects. CONCLUSION The prevalence of macrovascular disease and peripheral vascular disease were significantly higher in Korean patients with type 2 diabetes than in the normal population. However, no significant difference was noted in the prevalence of cardiovascular disease in females.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
| | - Mi Kwang Kwon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
| | - Ie Byung Park
- Department of Endocrinology, Gachon University of Science and Medicine, Incheon, Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
| | - In Ju Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sung-Hoon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea
| | - Hyoung Woo Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyung Soo Koh
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Doo Man Kim
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Moon Suk Nam
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Soo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
| | - Jeong-taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
| | - Young Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
- Research Institute of Endocrinology, Kyung Hee University, Seoul, Korea
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Yang X, So WY, Ma RC, Ko GT, Kong AP, Ho CS, Lam CW, Ozaki R, Cockram CS, Tong PC, Wong V, Chan JC. Thresholds of risk factors for ischemic stroke in type 2 diabetic patients with and without albuminuria: a non-linear approach. Clin Neurol Neurosurg 2008; 110:701-9. [PMID: 18514394 DOI: 10.1016/j.clineuro.2008.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 04/07/2008] [Accepted: 04/07/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Multiple risk factors in type 2 diabetes may explain their high risk for ischemic stroke (IS). However, it remains unknown whether these risk factors exhibit threshold characteristics and whether these relationships are influenced by albuminuria. The study aims to investigate whether risk factors exhibit any albuminuria specific threshold for IS. PATIENTS AND METHODS This is a prospective cohort study with 6969 Chinese type 2 diabetic patients without history of stroke after a median follow-up of 5.36 years. We identified thresholds of risk factors for IS using hazard ratio plots followed by confirmation using traditional Cox regression analysis. RESULTS In the non-albuminuric group (n=4008), IS risk started to increase rapidly at a body mass index threshold of 24 kg/m(2). The risk of IS declined with increasing blood hemoglobin reaching a threshold value of 14 g/dl. Using these threshold values as cutoff point, body mass index > or =24 kg/m(2) and hemoglobin <14 g/dl were associated with 2-fold increased risk of IS in these subjects. In the albuminuric group (n=2961). IS risk started to increase rapidly from a systolic blood pressure threshold of 135 mmHg and declined with increasing estimated glomerular filtration rate (eGFR) reaching a trough of 115 ml/min per 1.73 m(2). Using these values as cutoff points, patients with systolic blood pressure > or =135 mmHg and eGFR <115 ml/min per 1.73 m(2) had 2-fold increased risk of IS. CONCLUSION In type 2 diabetic patients, body mass index, hemoglobin, systolic blood pressure and eGFR exhibit different risk relationships and thresholds for IS contingent upon presence or absence of albuminuria.
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Affiliation(s)
- Xilin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
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Tseng CH, Tseng CP, Chong CK, Sheu JJ, Cheng JC. Angiotensin-converting enzyme gene polymorphism and stroke in type 2 diabetic patients in Taiwan. Eur J Clin Invest 2007; 37:483-91. [PMID: 17537156 DOI: 10.1111/j.1365-2362.2007.01813.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of traditional risk factors on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and stroke was rarely studied previously. We investigated such effect in Taiwanese type 2 diabetic patients. MATERIALS AND METHODS A total of 872 (422 men and 450 women) patients aged 63.5 (SD: 11.6) years were recruited. Among them, 92 cases (48 men and 44 women) had stroke. Polymerase chain reaction was used to classify the genotypes as II, ID and DD. Analyses were performed in separate sexes. RESULTS The adjusted odds ratios for stroke for ID vs. II and DD vs. II were 0.837 (0.413-1.697) and 1.778 (0.596-5.300), respectively, for men; but were 1.700 (0.824-3.505) and 3.706 (1.375-9.985), respectively, for women. In models assuming recessive (DD vs. II + ID), dominant (DD + ID vs. II) and additive (II = 0, ID = 1 and DD = 2) transmission, none of the odds ratios was significant for men; but were all significant for women: 2.784 (1.137-6.818), 1.996 (1.006-3.962) and 1.877 (1.155-3.050), respectively. In models using patients without risk factors (hypertension, obesity, smoking or dyslipidaemia ) as a referent group and comparing them to patients with the risk factor and with ID/II, and with DD genotypes, all models (except for smoking) favoured an increasing trend of risk with patients having the risk factor and DD genotype at the highest risk in women. Similar trends for hypertension and dyslipidaemia were also observed in men. CONCLUSION Traditional risk factors play an important role in the association between the ACE genotypes and stroke. Patients with DD genotype and having traditional risk factors are at the highest risk.
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Affiliation(s)
- C H Tseng
- National Taiwan University College of Medicine, Taipei, Taiwan.
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Tseng CH, Chong CK, Tseng CP, Cheng JC, Wong MK, Tai TY. Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: a 6.5-year follow-up study in Taiwan. Atherosclerosis 2007; 197:111-7. [PMID: 17395186 DOI: 10.1016/j.atherosclerosis.2007.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 02/09/2007] [Accepted: 02/13/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the mortality, causes of death and associated risk factors in Taiwanese diabetic patients after lower-extremity amputation (LEA). METHODS A total of 358 diabetic patients (191 men and 167 women, aged 66.6+/-10.3 years) after LEA from the Taiwanese cohort of 778 cases previously recruited in the multinational Global Lower Extremity Amputation Study were followed. Risk factors included age, sex, smoking, body mass index (BMI), hypertension, systolic (SBP) and diastolic blood pressure (DBP), and LEA level. Mortality was ascertained from the National Death Registry. RESULTS With a follow-up period of up to 6.5 (median: 4.0) years and 1239.17 patient-years, 214 patients died. Crude mortality rate was 172.7 per 1000 patient-years and median survival time 4.1 years. The underlying cause of death was recorded as diabetes mellitus in 57.9% of those who died and none to disease of arteries, arterioles and capillaries. After adjustment for age and sex, smoking, SBP as a continuous variable, SBP >or=140 mm Hg and BMI <18.5 kg/m(2) (underweight) were predictors for mortality with respective odds ratios (95% confidence intervals) of 1.580 (1.030-2.425), 1.011 (1.000-1.022), 1.363 (1.007-1.845) and 1.889 (1.203-2.968); but hypertension, DBP as a continuous variable and DBP >or=90 mm Hg, BMI as a continuous variable and LEA level were not. CONCLUSIONS Mortality after LEA in Taiwanese diabetic patients is high. The most common cause of death was recorded as diabetes mellitus. After adjustment for age and sex, smoking, SBP and underweight are predictive for mortality; while LEA level is not.
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Abstract
BACKGROUND This study compared the risk of hypertension between indigenous and Han adults with type 2 diabetes mellitus (T2DM) in Taiwan. METHODS The data of 89,857 (747 indigenous and 89,110 Han people) T2DM patients aged > or =18 years were extracted from an established cohort of 93 484 diabetic patients using the National Health Insurance system of Taiwan. The prevalence of hypertension before diabetes diagnosis and at the time of survey, and the incidence of hypertension after diabetes diagnosis were compared between the two ethnicities. RESULTS The indigenous people had a higher prevalence of hypertension before diabetes diagnosis (39.0% versus 29.4%, P < 0.001) and at the time of survey (66.9% versus 54.4%, P < 0.001); and showed poorer blood pressure control, with systolic pressure > or = 140 mmHg (38.4% versus 30.3%, P < 0.001) and diastolic pressure > or = 90 mmHg (20.4% versus 15.5%, P < 0.001). Logistic and Cox's regression models showed an adjusted risk of hypertension of about twofold in indigenous people compared to the Han people. CONCLUSIONS The indigenous diabetics are more prone to develop hypertension than their Han counterparts in Taiwan.
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Affiliation(s)
- Chin-Hsiao Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Tseng CH. Body mass index and waist circumference as determinants of coronary artery disease in Taiwanese adults with type 2 diabetes mellitus. Int J Obes (Lond) 2006; 30:816-21. [PMID: 16418754 DOI: 10.1038/sj.ijo.0803218] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the association between body mass index (BMI) and waist circumference (WC) and coronary artery disease (CAD) in Taiwanese type 2 diabetic patients. METHODS A total of 1183 (558 men and 625 women) patients aged 62.4+/-11.6 years were studied. CAD was diagnosed by history or an electrocardiogram by Minnesota codes. RESULTS The respective cutoffs of BMI and WC as determined by the receiver operating characteristic curves were 24.5 kg/m2 and 90 cm for men, and 25 kg/m2 and 80 cm for women. Distributions of CAD prevalence and multivariate-adjusted odds ratio (MAOR) for BMI cutoffs of 24.5 and 25 kg/m2 were quite similar in men. MAOR for WC above the respective cutoffs for men and women was 1.832 (1.267-2.648) and 1.450 (0.956-2.200, 0.05<P<0.1), and for BMI> or = 25 kg/m2 was 1.759 (1.213-2.551) and 1.471 (1.052-2.058) for men and women, respectively. Patients with BMI> or = 25 kg/m2 and WC > or = 90 cm for men or > or = 80 cm for women had the highest risk of CAD when compared to those without either risk factor, with respective MAOR of 2.053 (1.352-3.118) and 1.698 (1.071-2.691). CONCLUSION The recommended BMI and WC cutoffs for obesity for Asian adults are associated with CAD in Taiwanese T2DM.
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Affiliation(s)
- C-H Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Tseng CH, Tseng CP, Chong CK, Huang TP, Song YM, Chou CW, Lai SM, Tai TY, Cheng JC. Increasing incidence of diagnosed type 2 diabetes in Taiwan: analysis of data from a national cohort. Diabetologia 2006; 49:1755-60. [PMID: 16788802 DOI: 10.1007/s00125-006-0314-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 04/19/2006] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Epidemiological evidence shows an increasing prevalence of type 2 diabetes in Taiwan. The aim of this study was to assess the yearly incidence for this country during 1992-1996. SUBJECTS AND METHODS Data obtained by telephone interviews of 93,484 diagnosed diabetic patients enrolled in Taiwan's National Health Insurance programme formed the basis of this study. A total of 36,153 incident cases of type 2 diabetes (17,097 men and 19,056 women) were identified and incidence rates calculated. The trends of obesity and parental diabetes were also evaluated. RESULTS The overall 5-year incidences for men and women were 187.1 and 218.4 per 100,000 population, respectively. The trends from 1992-1996 were increased for all age groups in men and for most age groups in women. A 2.8-fold increase in incidence was observed for the youngest age group (<35 years), in which the increase in incidence was higher than in the older age groups. Men showed a higher fold increase in incidence than did women (3.5 vs 2.1). Obesity at interview increased from 39.2% in 1992 to 47.6% in 1996 (p<0.001) and was significant for all ages. Parental diabetes showed no yearly change when all patients were analysed together, but there was a trend towards a decrease in the youngest age group (<35 years) and a trend towards an increase in the oldest age groups (>/=55 years). CONCLUSIONS/INTERPRETATION An increasing incidence of diagnosed type 2 diabetes was observed for each sex in most age groups in Taiwan, but was most marked in the youngest age group. A parallel increase in obesity was observed with the increasing incidence of diabetes.
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Affiliation(s)
- C-H Tseng
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, Republic of China.
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Tseng CH. Prevalence of lower-extremity amputation among patients with diabetes mellitus: is height a factor? CMAJ 2006; 174:319-23. [PMID: 16446472 PMCID: PMC1373713 DOI: 10.1503/cmaj.050680] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Taller diabetic patients are at higher risk of peripheral sensory loss than shorter diabetic patients and thus may be at increased risk of lower-extremity ulcers and amputation. In a large telephone survey, the prevalence of lower-extremity amputation among patients with diabetes mellitus was determined and the association between height and lower-extremity amputation evaluated. METHODS Of 256,036 patients identified from hospital and clinic databases who had a diagnosis of diabetes and were seen at those institutions between 1995 and 1998, 128,572 were randomly selected to be interviewed by telephone between 1995 and 2002. Of the 93,484 patients who agreed to be interviewed, 386 were excluded (age < 18 years); this left 93,116 diabetec patients (42,970 men and 50,146 women) for inclusion in the study. RESULTS Of the 93,116 patients interviewed, 3259 (3.5%) had type 1 diabetes. Lower-extremity amputation was performed in 1.7% and 0.8% of the patients with type 1 and type 2 diabetes, respectively. The prevalence of amputation did not differ significantly between men and women with type 1 diabetes but was significantly higher among men than among women with type 2 diabetes (0.9% v. 0.7%). Height (every 10-cm increment) was significantly associated with lower-extremity amputation (adjusted odds ratio [OR] 1.16, 95% confidence interval [CI] 1.03-1.32). In a subgroup of 9295 patients for whom data on fasting plasma glucose levels and dyslipidemia were available, and after additional adjustment for these 2 variables, body height remained an independent predictor of lower-extremity amputation (adjusted OR for every 10 cm of height 1.79, 95% CI 1.14-2.82). INTERPRETATION Height is an independent predictor of lower-extremity amputation among patients with type 1 and type 2 diabetes mellitus.
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Affiliation(s)
- Chin-Hsiao Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Tseng CH, Tseng CP, Chong CK, Cheng JC, Tai TY. Independent association between triglycerides and coronary artery disease in Taiwanese type 2 diabetic patients. Int J Cardiol 2005; 111:80-5. [PMID: 16213608 DOI: 10.1016/j.ijcard.2005.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 07/23/2005] [Accepted: 07/24/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study evaluated the association between triglycerides (TG) and coronary artery disease (CAD) in Taiwanese adults with type 2 diabetes mellitus (T2DM). METHODS A total of 1150 patients (542 men and 608 women) aged 62.5+/-11.6 years were studied. CAD was diagnosed by history or an abnormal electrocardiogram (coronary probable or possible by Minnesota codes). Age, body mass index (BMI), smoking, use of insulin, anti-hypertensive agents and lipid-lowering agents, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were considered as potential confounders. RESULTS Patients with CAD were older, had higher prevalences of use of anti-hypertensive and lipid-lowering agents, and had higher BMI, SBP, DBP and TG. CAD increased significantly with increasing quartiles of TG (P-trend < 0.001). Ln(TG) was significantly correlated with BMI, FPG, HbA1c, DBP, TC, HDL-c (inversely) and LDL-c. Ln(TG) was associated with CAD with an unadjusted odds ratio of 1.411 (1.145-1.740). The odds ratio after adjustment for all confounders was slightly attenuated but still statistically significant: 1.380 (1.043-1.826). None of the other lipid parameters of TC, HDL-c and LDL-c were significantly associated with CAD in logistic models when they were entered for adjustment either separately or simultaneously. Sensitivity analyses by using history alone or history and coronary probable as diagnostic criteria for CAD did not change the association between TG and CAD. CONCLUSIONS TG is an independent risk factor for CAD in Taiwanese T2DM, independent of TC, HDL-c, LDL-c or other confounders.
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Affiliation(s)
- Chin-Hsiao Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
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Tseng CH, Tseng CP, Tai TY, Chong CK. Effect of angiotensin blockade on the association between albuminuria and peripheral arterial disease in elderly Taiwanese patients with type 2 diabetes mellitus. Circ J 2005; 69:965-70. [PMID: 16041168 DOI: 10.1253/circj.69.965] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to examine the impact of the clinical use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on the association between the urinary albumin/creatinine ratio (ACR) and ankle-brachial index (ABI) or peripheral arterial disease (PAD) in elderly Taiwanese patients with type 2 diabetes mellitus. METHODS AND RESULTS Two-hundred and ninety patients (108 men, 182 women) aged > or = 65 years (mean +/- SD, 71.6 +/-4.9) were cross-sectionally studied. ACR was expressed as the natural logarithm [ln(ACR)] and divided into normoalbuminuria (< 30.0 microg/mg) and albuminuria (> or = 30.0 microg/mg). ABI was evaluated both continuously and as peripheral arterial disease (PAD) (-) and PAD (+) using the cutoff of 0.9. Statistical analyses were performed with consideration of covariates and the use of ACEI/ARB. Results showed that in patients not using ACEI/ARB, ln (ACR) negatively correlated with ABI (r = -0.261, p < 0.01) and was associated with ABI with adjusted regression coefficient of -0.0213 (p < 0.05). PAD patients had a significantly higher level of ln (ACR) than those without PAD (4.83+/-1.34 vs 3.73+/-1.29, p < 0.001) and PAD prevalence was significantly higher in those with albuminuria than in those with normoalbuminuria (22.6% vs 4.9%, p < 0.001). The multivariate-adjusted odds ratio for PAD for every 1 unit increment of ln (ACR) was 2.10 (1.31-3.38), and for albuminuria vs normoalbuminuria 3.86 (1.04-14.31) in patients not using ACEI/ARB. In patients using ACEI/ARB, none of these analyses was significant. Patients using ACEI/ARB had a significantly lower risk of PAD with a multivariate-adjusted odds ratio of 0.34 (0.12-0.97). CONCLUSIONS ACR negatively correlates with ABI and is associated with PAD in elderly diabetic patients not treated with ACEI/ARB. The use of ACEI/ARB attenuates this association and may be associated with a lower risk of PAD.
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Affiliation(s)
- Chin-Hsiao Tseng
- Division of Endocrinology and Metabolism, National Taiwan University Hospital, Taipei, Taiwan.
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