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Su J, Fan X, Li M, Yu H, Geng H, Qin Y, Lu Y, Pei P, Sun D, Yu C, Lv J, Tao R, Zhou J, Ma H, Wu M. Association of lifestyle with reduced stroke risk in 41 314 individuals with diabetes: Two prospective cohort studies in China. Diabetes Obes Metab 2024; 26:2869-2880. [PMID: 38685601 DOI: 10.1111/dom.15606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
AIM To investigate the associations of individual and combined healthy lifestyle factors (HLS) with the risk of stroke in individuals with diabetes in China. METHODS This prospective analysis included 41 314 individuals with diabetes [15 191 from the Comprehensive Research on the Prevention and Control of the Diabetes (CRPCD) project and 26 123 from the China Kadoorie Biobank (CKB) study]. Associations of lifestyle factors, including cigarette smoking, alcohol consumption, physical activity, diet, body shape and sleep duration, with the risk of stroke, intracerebral haemorrhage (ICH) and ischaemic stroke (IS) were assessed using Cox proportional hazard models. RESULTS During median follow-up periods of 8.02 and 9.05 years, 2499 and 4578 cases of stroke, 2147 and 4024 of IS, and 160 and 728 of ICH were documented in individuals with diabetes in the CRPCD and CKB cohorts, respectively. In the CRPCD cohort, patients with ≥5 HLS had a 14% lower risk of stroke (hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.75-0.98) than those with ≤2 HLS. In the CKB cohort, the adjusted HR (95% CI) for patients with ≥5 HLS were 0.74 (0.66-0.83) for stroke, 0.74 (0.66-0.83) for IS, and 0.57 (0.42-0.78) for ICH compared with those with ≤2 HLS. The pooled adjusted HR (95% CI) comparing patients with ≥5 HLS versus ≤2 HLS was 0.79 (0.69-0.92) for stroke, 0.80 (0.68-0.93) for IS, and 0.60 (0.46-0.78) for ICH. CONCLUSIONS Maintaining a healthy lifestyle was associated with a lower risk of stroke, IS and ICH among individuals with diabetes.
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Affiliation(s)
- Jian Su
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xikang Fan
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Mengyao Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hao Yu
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Houyue Geng
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yu Qin
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yan Lu
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Dianjianyi Sun
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education (Peking University), Beijing, China
| | - Canqing Yu
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education (Peking University), Beijing, China
| | - Jun Lv
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education (Peking University), Beijing, China
| | - Ran Tao
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ming Wu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Noncommunicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Chen M, Wang M, Qiao M, Huang X, Li D, Yu L, Gan L, Chen W, Weng Y, Zhang J, Yu B, Liu J, Zhang L. Determinants influencing health-promoting behaviors in individuals at high risks of stroke: a cross-sectional study. Front Public Health 2024; 12:1323277. [PMID: 38912268 PMCID: PMC11190076 DOI: 10.3389/fpubh.2024.1323277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Background Quit smoking, moderate drinking, exercise, and healthy eating habits are all known to decrease the risk of stroke. As a result, understanding the health behaviors of high risk groups for stroke is crucial. Health behavior is influenced by knowledge, social environment, and health beliefs. However, little research has been done on these relationships. For a better grasp of the relationships mentioned above, consider using the COM-B model (capability, opportunity, motivation, and behavior). The purpose of this study was to investigate the variables related to health behavior and to test the mediating effect of health beliefs. Methods The cross-sectional study was carried out at a physical examination center of a tertiary hospital in Shanghai, China. 986 high-risk populations of stroke have been tested using the Health Behavior Scale (HBS-SP), Stroke Knowledge Questionnaire (SKQ), Health Beliefs Questionnaire (HBS), and Multidimensional Scale of Perceived Social Support (MSPSS). The structural equation modeling was used in this study. Results The scores for MSPSS, SKQ, HBS, and HBS-SP were 60.64 ± 13.72, 26.60 ± 9.77, 157.71 ± 34.34, and 2.46 ± 0.41, respectively. The revised model fits well (approximate root mean square error = 0.042; comparative fit index = 0.946). The health behavior was obviously and positively correlated to social Support, stroke knowledge, and health beliefs. Moreover, health belief has a mediating effect on the relation of social support, stroke knowledge, and health behavior. Conclusion Chinese high risk groups for stroke have a mediate level of health behaviors. Factors associated with health behaviors are knowledge of stroke, health beliefs, and social support. The COM-B-based model can be used to explain the health behavior of individuals at risk of stroke and to guide the formulation of effective health management programs.
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Affiliation(s)
- Mengxia Chen
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Mengdi Wang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Mengting Qiao
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Xiaorong Huang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Dongmei Li
- Neurovascular Center, Changhai Hospital, Shanghai, China
| | - Longjuan Yu
- Neurovascular Center, Changhai Hospital, Shanghai, China
| | - Lifen Gan
- Neurovascular Center, Changhai Hospital, Shanghai, China
| | - Wenyao Chen
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
| | - Yanqiu Weng
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
| | - Jingwen Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Bing Yu
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Shanghai, China
| | - Lingjuan Zhang
- Education and Scientific Research Department of Clinical Nursing, Changhai Hospital, Shanghai, China
- Shanghai Quality Control Center of Geriatric Care, Shanghai, China
- Key Laboratory of Geriatric Long-term Care (Naval Medical University), Ministry of Education, Shanghai, China
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Wei X, Xu M, Yang L, Gao Z, Kuang J, Zhou K. Determinants Influencing Health-Promoting Behaviors in Individuals at High Risk of Stroke: A Cross-Sectional Study. HEALTH EDUCATION & BEHAVIOR 2024; 51:457-466. [PMID: 36960724 DOI: 10.1177/10901981231160149] [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] [Indexed: 03/25/2023]
Abstract
BACKGROUND Health-promoting behaviors and positive lifestyle changes are crucial for effective stroke prevention. However, individuals at high risk of stroke exhibit poor health behavior due to a deficiency of individual motivation. Moreover, there are only a few studies on health-promoting behaviors that have applied behavior change theories in individuals at high risk of stroke. OBJECTIVE This study aimed to use the theory of the planned behavior (TPB) model to investigate determinants of health-promoting behaviors for stroke prevention and control. METHOD In this cross-sectional study, 263 participants were recruited from five community health centers in Qingdao. Confirmatory factor analysis was performed to assess the reliability and validity of the constructs, and structural equation modeling was used to analyze the proposed relationships between the TPB-related variables. RESULTS The attitudes, subjective norms, and perceptions of behavioral control positively influenced behavioral intention. The behavioral intention had a positive effect on health-promoting behaviors. Attitudes, subjective norms, and perceived behavioral control were influenced primarily by the mediating variable behavioral intention to affect health-promoting behaviors. Stroke knowledge was an influential facilitator of behavioral attitudes, subjective norms, and perceived behavior control. CONCLUSION The TPB-based model is suitable for explaining health-promoting behaviors in individuals at risk of stroke and for guiding the development of effective health management programs. A comprehensive person-centered motivation behavior strategy that is based on health education and complemented by social support and health resource optimization is critical in promoting health behavior motivation and health promotion behaviors in stroke high-risk groups.
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Affiliation(s)
- Xiao Wei
- Qingdao University, Qingdao, China
| | | | - Li Yang
- Qingdao University, Qingdao, China
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De Santis F, Romoli M, Foschi M, Sciancalepore FD, D'Anna L, Barba L, Abu-Rumeileh S, Sacco S, Ornello R. Risk of stroke with different levels of leisure-time physical activity: a systematic review and meta-analysis of prospective cohort studies. J Neurol Neurosurg Psychiatry 2024; 95:504-514. [PMID: 38443158 DOI: 10.1136/jnnp-2023-332457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/10/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Leisure-time physical activity (LTPA) protects against vascular diseases. Whether and to what extent different levels of LTPA, including lower ones, benefit stroke prevention is still unclear. METHODS We searched prospective cohort studies, indexed on PubMed and Scopus, published in English up to 22 April 2023, that investigated, in a general healthy population, the relationship between different predefined LTPA levels, compared with inactivity, and the risk of any type of stroke. We applied random effect modelling for meta-analyses and meta-regression to control for the impact of age and sex. RESULTS Out of 3064 screened articles, 15 articles on 16 cohorts of subjects were included in meta-analyses, with a total of 752 050 followed-up subjects. Mean follow-up was 125.7±77.5 months. Included studies identified three (none, below target and ideal) to five (none, insufficient, low, moderate and intense) levels of LTPA. In the five studies identifying three levels of LTPA, compared with no LTPA, below target (risk ratio (RR)=0.82, 95% CI=0.75 to 0.88) and ideal LTPA significantly reduced stroke risk (RR=0.71, 95% CI=0.58 to 0.86).Lower levels of LTPA also mitigated stroke risk in studies reporting on four (n=6; RR=0.73, 95% CI=0.62 to 0.87 favouring moderate LTPA over no LTPA) and five levels (n=2; RR=0.71, 95% CI=0.58 to 0.88 favouring moderate LTPA over no LTPA). The benefits of LTPA were independent of age and sex. CONCLUSIONS According to our results, all levels of LTPA can be beneficial for stroke prevention, including levels currently regarded as low or insufficient. People should be encouraged to be physically active even at the lowest levels. PROSPERO REGISTRATION NUMBER CRD42023425302.
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Affiliation(s)
- Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Romoli
- Department of Neuroscience, Neurology and Stroke Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Lucio D'Anna
- Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, UK
| | - Lorenzo Barba
- Department of Neurology, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Garcia L, Pearce M, Abbas A, Mok A, Strain T, Ali S, Crippa A, Dempsey PC, Golubic R, Kelly P, Laird Y, McNamara E, Moore S, de Sa TH, Smith AD, Wijndaele K, Woodcock J, Brage S. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose-response meta-analysis of large prospective studies. Br J Sports Med 2023; 57:979-989. [PMID: 36854652 PMCID: PMC10423495 DOI: 10.1136/bjsports-2022-105669] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To estimate the dose-response associations between non-occupational physical activity and several chronic disease and mortality outcomes in the general adult population. DESIGN Systematic review and cohort-level dose-response meta-analysis. DATA SOURCES PubMed, Scopus, Web of Science and reference lists of published studies. ELIGIBILITY CRITERIA Prospective cohort studies with (1) general population samples >10 000 adults, (2) ≥3 physical activity categories, and (3) risk measures and CIs for all-cause mortality or incident total cardiovascular disease, coronary heart disease, stroke, heart failure, total cancer and site-specific cancers (head and neck, myeloid leukaemia, myeloma, gastric cardia, lung, liver, endometrium, colon, breast, bladder, rectum, oesophagus, prostate, kidney). RESULTS 196 articles were included, covering 94 cohorts with >30 million participants. The evidence base was largest for all-cause mortality (50 separate results; 163 415 543 person-years, 811 616 events), and incidence of cardiovascular disease (37 results; 28 884 209 person-years, 74 757 events) and cancer (31 results; 35 500 867 person-years, 185 870 events). In general, higher activity levels were associated with lower risk of all outcomes. Differences in risk were greater between 0 and 8.75 marginal metabolic equivalent of task-hours per week (mMET-hours/week) (equivalent to the recommended 150 min/week of moderate-to-vigorous aerobic physical activity), with smaller marginal differences in risk above this level to 17.5 mMET-hours/week, beyond which additional differences were small and uncertain. Associations were stronger for all-cause (relative risk (RR) at 8.75 mMET-hours/week: 0.69, 95% CI 0.65 to 0.73) and cardiovascular disease (RR at 8.75 mMET-hours/week: 0.71, 95% CI 0.66 to 0.77) mortality than for cancer mortality (RR at 8.75 mMET-hours/week: 0.85, 95% CI 0.81 to 0.89). If all insufficiently active individuals had achieved 8.75 mMET-hours/week, 15.7% (95% CI 13.1 to 18.2) of all premature deaths would have been averted. CONCLUSIONS Inverse non-linear dose-response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. PROSPERO registration number CRD42018095481.
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Affiliation(s)
- Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Sara Ali
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paddy C Dempsey
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport, Physical Education and Health Sciences, Edinburgh, UK
| | - Yvonne Laird
- Sydney School of Public Health, Prevention Research Collaboration, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Eoin McNamara
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Economic and Social Research Institute, Dublin, Ireland
| | - Samuel Moore
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Thiago Herick de Sa
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrea D Smith
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Sun J, Qiao Y, Zhao M, Magnussen CG, Xi B. Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15-39 years in 204 countries/territories, 1990-2019: a systematic analysis of Global Burden of Disease Study 2019. BMC Med 2023; 21:222. [PMID: 37365627 PMCID: PMC10294522 DOI: 10.1186/s12916-023-02925-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Understanding the temporal trends in the burden of overall and type-specific cardiovascular diseases (CVDs) in youths and young adults and its attributable risk factors is important for effective and targeted prevention strategies and measures. We aimed to provide a standardized and comprehensive estimation of the prevalence, incidence, disability-adjusted life years (DALY), and mortality rate of CVDs and its associated risk factors in youths and young adults aged 15-39 years at global, regional, and national levels. METHODS We applied Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 analytical tools to calculate the age-standardized incidence, prevalence, DALY, and mortality rate of overall and type-specific CVDs (i.e., rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, aortic aneurysm, and endocarditis) among youths and young adults aged 15-39 years by age, sex, region, sociodemographic index and across 204 countries/territories from 1990 to 2019, and proportional DALY of CVDs attributable to associated risk factors. RESULTS The global age-standardized DALY (per 100,000 population) for CVDs in youths and young adults significantly decreased from 1257.51 (95% confidence interval 1257.03, 1257.99) in 1990 to 990.64 (990.28, 990.99) in 2019 with an average annual percent change (AAPC) of - 0.81% (- 1.04%, - 0.58%, P < 0.001), and the age-standardized mortality rate also significantly decreased from 19.83 (19.77, 19.89) to 15.12 (15.08, 15.16) with an AAPC of - 0.93% (- 1.21%, - 0.66%, P < 0.001). However, the global age-standardized incidence rate (per 100,000 population) moderately increased from 126.80 (126.65, 126.95) in 1990 to 129.85 (129.72, 129.98) in 2019 with an AAPC of 0.08% (0.00%, 0.16%, P = 0.040), and the age-standardized prevalence rate significantly increased from 1477.54 (1477.03, 1478.06) to 1645.32 (1644.86, 1645.78) with an AAPC of 0.38% (0.35%, 0.40%, P < 0.001). In terms of type-specific CVDs, the age-standardized incidence and prevalence rate in rheumatic heart disease, prevalence rate in ischemic heart disease, and incidence rate in endocarditis increased from 1990 to 2019 (all P < 0.001). When stratified by sociodemographic index (SDI), the countries/territories with low and low-middle SDI had a higher burden of CVDs than the countries/territories with high and high-middle SDI. Women had a higher prevalence rate of CVDs than men, whereas men had a higher DALY and mortality rate than women. High systolic blood pressure, high body mass index, and low-density lipoprotein cholesterol were the main attributable risk factors for DALY of CVDs for all included countries and territories. Household air pollution from solid fuels was an additional attributable risk factor for DALY of CVDs in low and low-middle SDI countries compared with middle, high-middle, and high SDI countries. Compared with women, DALY for CVDs in men was more likely to be affected by almost all risk factors, especially for smoking. CONCLUSIONS There is a substantial global burden of CVDs in youths and young adults in 2019. The burden of overall and type-specific CVDs varied by age, sex, SDI, region, and country. CVDs in young people are largely preventable, which deserve more attention in the targeted implementation of effective primary prevention strategies and expansion of young-people's responsive healthcare systems.
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Affiliation(s)
- Jiahong Sun
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Yanan Qiao
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China.
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Holder C, Krishnamurthi R, Theadom A. Exploring facilitators and barriers to long-term behavior change following health-wellness coaching for stroke prevention: A qualitative study conducted in Auckland, New Zealand. Brain Behav 2023; 13:e2671. [PMID: 36510702 PMCID: PMC9847597 DOI: 10.1002/brb3.2671] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Health-wellness coaching (HWC) has grown in popularity as a means of empowering individuals to take responsibility for their health behavior and make lifestyle changes to reduce their risk of stroke. Understanding the facilitators and barriers to long-term behavior change is key if preventive strategies such as HWC are to be robust and effective. This study aimed to explore the experiences of people at risk of stroke after receiving HWC for stroke prevention, specifically the facilitators and barriers to long-term behavior change from the perspective of study participants. METHODS All participants received HWC as part of a randomized controlled trial 3 years earlier. Semi-structured telephone interviews were conducted with eight participants from the trial sample. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key concepts and themes. RESULTS Three overarching themes were identified: "Awakening of the mind" captured the importance of seeing the bigger picture, recognizing the impact of potential disease and using skills and tools to support decision-making. "It's not just about health behavior" conveyed the importance of being respectfully responsive to individual need and addressing emotional well-being alongside physical health. "Social connectedness" encapsulated the significance of community engagement, accountability, and paying it forward. CONCLUSIONS Enhancing awareness of personal risk and the impact of potential disease are facilitators of long-term behavior change and should be incorporated into coaching conversations. This supports the process of "waking up" to health needs and the possibility of change, which are important precursors to long-term change. Health coaching should be responsive to individual need, with emotional well-being, happiness, and life satisfaction being addressed alongside physical health. The opportunity to develop skills to support decision-making and self-management should be included in coaching initiatives, to enhance self-efficacy and help facilitate long-term behavior change.
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Affiliation(s)
- Caroline Holder
- National Institute of Stroke and Applied Neurosciences (NISAN), Auckland, New Zealand
| | | | - Alice Theadom
- Faculty of Health and Environmental Sciences, Auckland, New Zealand
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Sabayan B. Primary Prevention of Ischemic Stroke. Semin Neurol 2022; 42:571-582. [PMID: 36395819 DOI: 10.1055/s-0042-1758703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, HealthPartners Neuroscience Center, St. Paul, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Alkahtani R. Molecular mechanisms underlying some major common risk factors of stroke. Heliyon 2022; 8:e10218. [PMID: 36060992 PMCID: PMC9433609 DOI: 10.1016/j.heliyon.2022.e10218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Ischemic and hemorrhagic strokes are the most common known cerebrovascular disease which can be induced by modifiable and non-modifiable risk factors. Age and race are the most common non-modifiable risk factors of stroke. However, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and cardiovascular disorders are major modifiable risk factors. Understanding the molecular mechanism mediating each of these risk factors is expected to contribute significantly to reducing the risk of stroke, preventing neural damage, enhancing rehabilitation, and designing suitable treatments. Abnormalities in the structure of the blood-brain barrier and blood vessels, thrombosis, vasoconstriction, atherosclerosis, reduced cerebral blood flow, neural oxidative stress, inflammation, and apoptosis, impaired synaptic transmission, excitotoxicity, altered expression/activities of many channels and signaling proteins are the most knows mechanisms responsible for stroke induction. However, the molecular role of risk factors in each of these mechanisms is not well understood and requires a lot of search and reading. This review was designed to provide the reader with a single source of information that discusses the current update of the prevalence, pathophysiology, and all possible molecular mechanisms underlying some major risk factors of stroke namely, hypertension, diabetes mellitus, dyslipidemia, and lipid fraction, and physical inactivity. This provides a full resource for understanding the molecular effect of each of these risk factors in stroke.
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Affiliation(s)
- Reem Alkahtani
- Department of Basic Medical Sciences, College of Medicine at King Saud, Abdulaziz, University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
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10
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Hämmerle M, Forer L, Schönherr S, Peters A, Grallert H, Kronenberg F, Gieger C, Lamina C. A Family and a Genome-Wide Polygenic Risk Score Are Independently Associated With Stroke in a Population-Based Study. Stroke 2022; 53:2331-2339. [PMID: 35387493 DOI: 10.1161/strokeaha.121.036551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Positive family history and genetic risk scores have been shown to independently capture those individuals with high risk for stroke. The aim of our study was to evaluate the amount of shared information between family history and genetic risk and to investigate their combined effect on the association with prevalent and incident stroke cases. METHODS We obtained a family risk score (FamRS), weighted for disease onset and family size as well as genome-wide polygenic risk score (PGS) including over 3.2 million single-nucleotide polymorphisms in the population-based prospective KORA F3 (Cooperative Health Research in the Region of Augsburg) study (n=3071) from Southern Germany. FamRS and PGS were evaluated separately and combined. The measures were once treated as continuous variables but also divided in the highest 20%, 10%, 5%, and 1% percentiles. Odds ratios via logistic regression and hazard ratios via Cox regression were estimated. A stroke event was defined as a hospitalization for stroke that was self-reported in a standardized interview by certified and supervised personnel. RESULTS The FamRS outperformed other simplified family measures such as affected parents or number of affected family members. FamRS and PGS were not correlated, and no individuals were observed with both very high FamRS and very high PGS (top 1% percentile). In a combined model, both FamRS and PGS were independently from each other associated with risk of stroke, also independent of other traditional risk factors (p [FamRS]=0.02, p [PGS]=0.005). Individuals in the top 1% of either FamRS or PGS were found to have >5-fold risk for stroke (odds ratios, 5.82 [95% CI, 2.08-14]; P=0.0002). The results for incident stroke events showed the same trend but were not significant. CONCLUSIONS Our study shows that a family risk score and PGS capture different information concerning individual stroke risk. Combining the risk measures FamRS and PGS increases predictive power, as demonstrated in a population-based study.
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Affiliation(s)
- Michelle Hämmerle
- Institute of Genetic Epidemiology, Department of Genetics, Medical University of Innsbruck, Innsbruck, Austria (M.H., L.F., S.H., F.K., C.L.)
| | - Lukas Forer
- Institute of Genetic Epidemiology, Department of Genetics, Medical University of Innsbruck, Innsbruck, Austria (M.H., L.F., S.H., F.K., C.L.)
| | - Sebastian Schönherr
- Institute of Genetic Epidemiology, Department of Genetics, Medical University of Innsbruck, Innsbruck, Austria (M.H., L.F., S.H., F.K., C.L.)
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (A.P., C.G., H.G.).,German Center for Diabetes Research (DZD), Neuherberg, Germany (A.P., C.G., H.G.).,German Research Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany (A.P.)
| | - Harald Grallert
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (A.P., C.G., H.G.).,German Center for Diabetes Research (DZD), Neuherberg, Germany (A.P., C.G., H.G.)
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics, Medical University of Innsbruck, Innsbruck, Austria (M.H., L.F., S.H., F.K., C.L.)
| | - Christian Gieger
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany (A.P., C.G., H.G.).,German Center for Diabetes Research (DZD), Neuherberg, Germany (A.P., C.G., H.G.)
| | - Claudia Lamina
- Institute of Genetic Epidemiology, Department of Genetics, Medical University of Innsbruck, Innsbruck, Austria (M.H., L.F., S.H., F.K., C.L.)
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11
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Madsen TE, Samaei M, Pikula A, Yu AYX, Carcel C, Millsaps E, Yalamanchili RS, Bencie N, Dula AN, Leppert M, Rundek T, Dreyer RP, Bushnell C. Sex Differences in Physical Activity and Incident Stroke: A Systematic Review. Clin Ther 2022; 44:586-611. [PMID: 35418311 PMCID: PMC9195871 DOI: 10.1016/j.clinthera.2022.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Physical inactivity, a modifiable risk factor for cardiovascular disease, is independently associated with stroke. Though some prior data have suggested sex differences in levels of physical activity, whether there are sex differences in the role of physical activity in primary stroke prevention is largely unknown. This systematic review identifies and describes recent findings on sex differences in the association between physical activity and incident (first-ever) stroke. This review also describes the current evidence on the strength of the association between physical activity and a reduced stroke risk in women in particular. METHODS Using a prespecified strategy, PubMed/MEDLINE and Cochrane Central were searched to identify observational studies or trials published from 2000 to 2020 and reporting sex differences in physical activity and incident stroke. To be included, among other criteria, studies had to include sex-specific effect estimates from women, men, or both. Titles, abstracts, and full-text articles were screened to identify studies meeting the inclusion criteria, and adjusted sex-specific estimates of the association between physical activity and incident stroke for total stroke (ischemic plus hemorrhagic) or ischemic stroke were abstracted. FINDINGS Thirty-seven studies met the inclusion criteria. Of 17 studies that included data on total incident stroke (ischemic and hemorrhagic combined) in both women and men, 7 (41%) showed similar associations between physical activity and incident stroke between women and men, 6 (35%) suggested a significant effect in women but not in men, and 3 (18%) showed a significant effect in men but not in women. Of 10 studies that included data on ischemic stroke in women and men, 5 (50%) suggested similar effects in women and men, 4 (40%) suggested a significant effect in women but not in men, and 1 (10%) showed an effect in men but not women. In women specifically, the majority of included studies demonstrated a reduced risk for incident stroke with physical activity, with relative risk reductions ranging from 11% to 72%, though most estimates fell between 20% and 40%. IMPLICATIONS The majority of studies indicated a clear association between physical activity and a reduction in stroke risk. Studies were split as to the potential for sex differences in this association. Future prospective investigations should identify strategies for the use of increased physical activity for primary stroke prevention, with sex-specific considerations as warranted. The data on sex-specific dose-response relationship between physical activity and stroke risk are inconclusive and warrant more research.
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Affiliation(s)
- Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School, and the Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
| | - Mehrnoosh Samaei
- Department of Emergency Medicine, Division of Sex and Gender in Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Aleksandra Pikula
- Department of Medicine (Neurology), University of Toronto, University Health Networks, Toronto, Ontario, Canada
| | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Nicole Bencie
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Adrienne N Dula
- Departments of Neurology and Diagnostic Medicine, Dell Medical School, University of Texas, Austin, Texas
| | - Michelle Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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12
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Ding Q, Liu S, Yao Y, Liu H, Cai T, Han L. Global, Regional, and National Burden of Ischemic Stroke, 1990-2019. Neurology 2021; 98:e279-e290. [PMID: 34911748 DOI: 10.1212/wnl.0000000000013115] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To our knowledge, no comprehensive update of the descriptive epidemiology and trends of ischemic stroke has been released since Global Burden of Disease (GBD) 2017. To examine ischemic stroke burdens at global, regional and national levels in terms of sex, age and social development index (SDI). METHODS Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, mortality, and disability-adjusted life-years (DALY) trends of ischemic stroke. Measures were stratified by sex, region, country, age and SDI. RESULTS The global age-standardized incidence rate (ASIR) of ischemic stroke decreased from 1990 to 2019, with an EAPC of -0.43 [95% confidence interval (CI), -0.54 to -0.32]. High-middle and middle SDI regions had much higher ASIR, ASDR and age-standardized DALY rates due to ischemic stroke than other SDI regions. Regionally, East Asia had the highest ASIR of ischemic stroke in 2019 and the largest increase in the ASIR from 1990 to 2019. Nationally, Egypt (EAPC, 1.40; 95% CI, 1.27 to 1.52) and China (EAPC, 1.10; 95% CI, 1.00 to 1.20) had the most pronounced increases in the ASIR of ischemic stroke. Globally, there was an increase in ischemic stroke incidence with increasing age, especially in females aged 50-69 years or older. The global age-standardized death rate (ASDR) decreased from 1990 to 2019, with an EAPC of -1.63 (95% CI, -1.72 to -1.53). The ASDR and age-standardized DALY rates increased most in Southern sub-Saharan Africa, Eastern sub-Saharan Africa and Southeast Asia. CONCLUSIONS The ASIR, ASDR and the age-standardized DALY rates remained high in high-middle and middle SDI regions. East Asia, Southern sub-Saharan Africa, Eastern sub-Saharan Africa, and Southeast Asia had the greatest burden of ischemic stroke. Globally, females had a greater burden of ischemic stroke than males, especially those aged 50-69 years or older.
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Affiliation(s)
- Quanquan Ding
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Medicine and Division of Hematology/Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA
| | - Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yindan Yao
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Huina Liu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Ting Cai
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Liyuan Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China .,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
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13
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Degroote L, De Paepe A, De Bourdeaudhuij I, Van Dyck D, Crombez G. Effectiveness of the mHealth intervention 'MyDayPlan' to increase physical activity: an aggregated single case approach. Int J Behav Nutr Phys Act 2021; 18:92. [PMID: 34233718 PMCID: PMC8265041 DOI: 10.1186/s12966-021-01163-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background e- and mHealth interventions using self-regulation techniques like action and coping planning have the potential to tackle the worldwide problem of physical inactivity. However, they often use one-week self-regulation cycles, providing support toward an active lifestyle on a weekly basis. This may be too long to anticipate on certain contextual factors that may fluctuate from day to day and may influence physical activity. Consequently, the formulated action and coping plans often lack specificity and instrumentality, which may decrease effectiveness of the intervention. The aim of this study was to evaluate effectiveness of a self-regulation, app-based intervention called ‘MyDayPlan’. “MyDayPlan’ provides an innovative daily cycle in which users are guided towards more physical activity via self-regulation techniques such as goal setting, action planning, coping planning and self-monitoring of behaviour. Methods An ABAB single-case design was conducted in 35 inactive adults between 18 and 58 years (M = 40 years). The A phases (A1 and A2) were the control phases in which the ‘MyDayPlan’ intervention was not provided. The B phases (B1 and B2) were the intervention phases in which ‘MyDayPlan’ was used on a daily basis. The length of the four phases varied within and between the participants. Each phase lasted a minimum of 5 days and the total study lasted 32 days for each participant. Participants wore a Fitbit activity tracker during waking hours to assess number of daily steps as an outcome. Single cases were aggregated and data were analysed using multilevel models to test intervention effects and possible carry-over effects. Results Results showed an average intervention effect with a significant increase in number of daily steps from the control to intervention phases for each AB combination. From A1 to B1, an increase of 1424 steps (95% CI [775.42, 2072.32], t (1082) = 4.31,p < .001), and from A2 to B2, an increase of 1181 steps (95% CI [392.98, 1968.16], t (1082) = 2.94, p = .003) were found. Furthermore, the number of daily steps decreased significantly (1134 steps) when going from the first intervention phase (B1) to the second control phase (A2) (95% CI [− 1755.60, − 512.38], t (1082) = − 3.58, p < .001). We found no evidence for a difference in trend between the two control (95% CI [− 114.59, 197.99], t (1078) = .52, p = .60) and intervention phases (95% CI [− 128.79,284.22], t (1078) = .74, p = .46). This reveals, in contrast to what was hypothesized, no evidence for a carry-over effect after removing the ‘MyDayPlan’ app after the first intervention phase (B1). Conclusion This study adds evidence that the self-regulation mHealth intervention, ‘MyDayPlan’ has the capacity to positively influence physical activity levels in an inactive adult population. Furthermore, this study provides evidence for the potential of interventions adopting a daily self-regulation cycle in general. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01163-2.
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Affiliation(s)
- L Degroote
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders, Brussels, Belgium. .,Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium.
| | - A De Paepe
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - D Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - G Crombez
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
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14
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3198] [Impact Index Per Article: 1066.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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15
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Abstract
PURPOSE OF REVIEW This article provides an update on the epidemiology and prevention of a first stroke. Risk factor modification plays a large role in stroke prevention. Strategies for early intervention, particularly for hypertension, are critical for reducing stroke morbidity and mortality. RECENT FINDINGS Because of the new criteria for hypertension, more people are now classified as hypertensive and can benefit from lifestyle or medical management. Direct oral anticoagulants have made it easier to safely treat patients with atrial fibrillation and are now considered first-line therapy for patients with an additional stroke risk factor. SUMMARY Primary prevention of stroke is essential for maintaining brain health throughout the life span. Adherence to a healthy lifestyle and routine screening for stroke risk factors can promote healthy, stroke-free aging.
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16
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Gittins M, Ashton C, Holden N, Cross S, Meadipudi S, Kawafi K, Burger I, Rickard S, Vail A, Molloy J, Smith CJ. Environmental Factors and Hyperacute Stroke Care Activity During the COVID-19 Pandemic: An Interrupted Time-Series Analysis. J Stroke Cerebrovasc Dis 2020; 29:105229. [PMID: 32828638 PMCID: PMC7402099 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors. METHODS Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges. RESULTS The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here. CONCLUSION Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID-19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health outcomes.
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Affiliation(s)
- Matthew Gittins
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M139PL, UK.
| | - Christopher Ashton
- Greater Manchester Stroke Operational Delivery Network, Hosted by Salford Royal Hospital, Salford, UK
| | - Neil Holden
- Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK
| | - Stephen Cross
- Hyperacute Stroke Unit, Stepping Hill Hospital, Stockport, UK
| | | | - Khalil Kawafi
- Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Ilse Burger
- Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK
| | - Sarah Rickard
- Greater Manchester Stroke Operational Delivery Network, Hosted by Salford Royal Hospital, Salford, UK
| | - Andy Vail
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M139PL, UK
| | - Jane Molloy
- Greater Manchester Stroke Operational Delivery Network, Hosted by Salford Royal Hospital, Salford, UK; Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK
| | - Craig J Smith
- Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal Hospital, Salford, UK; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
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17
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Degroote L, Van Dyck D, De Bourdeaudhuij I, De Paepe A, Crombez G. Acceptability and feasibility of the mHealth intervention 'MyDayPlan' to increase physical activity in a general adult population. BMC Public Health 2020; 20:1032. [PMID: 32600352 PMCID: PMC7325032 DOI: 10.1186/s12889-020-09148-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022] Open
Abstract
Background Electronic health (eHealth) and mobile health (mHealth) interventions have the potential to tackle the worldwide problem of physical inactivity. However, they often suffer from large attrition rates. Consequently, feasibility and acceptability of interventions have become important matters in the creation of e- and mHealth interventions. The aim of this study was to evaluate participants’ opinions regarding acceptability and feasibility of a self-regulation, app-based intervention called ‘MyDayPlan’. ‘MyDayPlan’ provides an innovative daily cycle providing several self-regulation techniques throughout the day that guide users towards an active lifestyle via various self-regulation techniques. Methods Semi-structured interviews were conducted with 20 adults after using the app for 2 weeks. A directed content analysis was performed using NVivo Software. Results ‘MyDayPlan’ was well-received and seems to be feasible and acceptable with inactive adults. The straightforward lay out and ease of use of the app were appreciated. Furthermore, the incorporation of the techniques ‘action planning’, and ‘prompting review of behavioral goals’ was positively evaluated. However, the users gave some recommendations: implementation of activity trackers to self-monitor physical activity could be of added value. Furthermore, increasing intuitiveness by minimizing text input and providing more preprogrammed options could further increase the ease of use. Finally, users indicated that they would benefit from more guidance during the “coping planning” component (barrier identification/problem solving), for example by receiving more tailored examples. Conclusions Based on these findings, adaptations will be made to the ‘MyDayPlan’ app before evaluating its effectiveness. Furthermore, involving potential end users and evaluating acceptability and feasibility during the development of an e- and mHealth intervention is key. Also, creating interventions with a large ease of use and straightforward layout that provides tailored support during action and coping planning is key.
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Affiliation(s)
- L Degroote
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders, Brussels, Belgium. .,Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium.
| | - D Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - A De Paepe
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
| | - G Crombez
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
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18
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4966] [Impact Index Per Article: 1241.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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19
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5437] [Impact Index Per Article: 1087.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Mokhayeri Y, Hashemi-Nazari SS, Khodakarim S, Safiri S, Mansournia N, Mansournia MA, Kaufman JS, Naimi AI. Effects of Hypothetical Interventions on Ischemic Stroke Using Parametric G-Formula. Stroke 2019; 50:3286-3288. [DOI: 10.1161/strokeaha.119.025749] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background and Purpose—
Standard analytic approaches (eg, logistic regression) fail to adequately control for time-dependent confounding and, therefore, may yield biased estimates of the total effect of the exposure on the outcome. In the present study, we estimate the effect of body mass index, intentional physical activity, HDL (high-density lipoprotein) cholesterol, LDL (low-density lipoprotein) cholesterol, hypertension, and cigarette smoking on the 11-year risk of ischemic stroke by sex using the parametric g-formula to control time-dependent confounders.
Methods—
Using data from the MESA (Multi-Ethnic Study of Atherosclerosis), we followed 6809 men and women aged 45 to 84 years. We estimated the risk of stroke under 6 hypothetical interventions: maintaining body mass index <25 kg/m
2
, maintaining normotension (systolic blood pressure <140 and diastolic <90 mm Hg), quitting smoking, maintaining HDL >1.55 mmol/L, maintaining LDL <3.11 mmol/L, and exercising at least 210 minutes per week. The effects of joint hypothetical interventions were also simulated.
Results—
In men, the 11-year risk of ischemic stroke would be reduced by 85% (95% CI, 66–96) for all 6 hypothetical interventions. In women, this same effect was estimated as 55% (95% CI, 6–82).
Conclusions—
The hypothetical interventions explored in our study resulted in risk reduction in both men and women.
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Affiliation(s)
- Yaser Mokhayeri
- From the Department of Epidemiology and Biostatistics, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran (Y.M.)
| | - Seyed Saeed Hashemi-Nazari
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center (S.S.H.-N.), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Khodakarim
- Department of Epidemiology, School of Public Health (S.K.), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Aging Research Institute, Tabriz University of Medical Sciences, Iran (S.S.)
- Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Iran (S.S.)
| | - Nasrin Mansournia
- Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran (N.M.)
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (M.A.M.)
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, CA (J.S.K.)
| | - Ashley I. Naimi
- Department of Epidemiology, University of Pittsburgh PA (A.I.N.)
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21
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Brainin M, Feigin V, Bath PM, Collantes E, Martins S, Pandian J, Sacco R, Teuschl Y. Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. Int J Stroke 2019; 14:818-825. [DOI: 10.1177/1747493019873706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Epifania Collantes
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, FL, USA
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
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22
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Zhou Z, Lin C, Ma J, Towne SD, Han Y, Fang Y. The Association of Social Isolation With the Risk of Stroke Among Middle-Aged and Older Adults in China. Am J Epidemiol 2019; 188:1456-1465. [PMID: 31150041 DOI: 10.1093/aje/kwz099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 12/21/2022] Open
Abstract
Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.
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Affiliation(s)
- Zi Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Cen Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jiaping Ma
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Samuel D Towne
- Department of Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, Florida
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas
- Center for Population Health and Aging, Texas A&M University, College Station, Texas
| | - Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
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Yu L, Liang Q, Zhou W, Huang X, Hu L, You C, Li J, Wu Y, Li P, Wu Q, Wang Z, Gao R, Bao H, Cheng X. Association between physical activity and stroke in a middle-aged and elderly Chinese population. Medicine (Baltimore) 2018; 97:e13568. [PMID: 30572457 PMCID: PMC6319969 DOI: 10.1097/md.0000000000013568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Accumulating evidence has reported that physical activity (PA) is effective in reducing stroke and mortality. However, whether PA levels are associated with stroke in middle-aged and elderly people in Jiangxi Province of China remains unclear. In the present study, we evaluated the association between PA and the risk of stroke in Jiangxi Province of China. METHODS A cross-sectional survey was conducted in Jiangxi Province of China from November 2013 to August 2014, using standardized questionnaire forms and physical measurements. Self-reported PA was assessed using the international PA questionnaire. A history of stroke was self-reported by answering the questionnaire. Multivariate logistic regression analysis was performed to evaluate the association between PA levels and the risk of stroke after adjustment for sociodemographic characteristics, lifestyle factors, and disease-related risk factors. RESULTS A total of 10,398 participants (4240 men and 6158 women, aged 45 to 97 years) completed the International Physical Activity Questionnaire (IPAQ). Compared with low-intensity PA, vigorous PA was associated with graded reduction in the risk of stroke (odds ratio [OR] of 0.763, 95% confidence interval [CI] 0.717-0.812, P < .001 for trend). However, there were no significant differences between individuals in the low-intensity PA and moderate-intensity PA group (P > 0.05). CONCLUSIONS Compared with low PA, vigorous PA, but not moderate PA, was associated with a lower risk of stroke in middle aged and elderly people in southern China, specifically among men. These findings suggested that increasing PA is beneficial.
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Affiliation(s)
| | - Qian Liang
- Key Laboratory of Molecular Biology in Jiangxi Province, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi
| | - Wei Zhou
- Department of Cardiovascular Medicine
| | | | - Lihua Hu
- Department of Cardiovascular Medicine
| | | | | | | | - Ping Li
- Department of Cardiovascular Medicine
| | | | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Fengcunxili, Mentougou District
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beilishilu, Xicheng District, Beijing, China
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Barbaresko J, Rienks J, Nöthlings U. Lifestyle Indices and Cardiovascular Disease Risk: A Meta-analysis. Am J Prev Med 2018; 55:555-564. [PMID: 30241617 DOI: 10.1016/j.amepre.2018.04.046] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/31/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Several studies investigated lifestyle indices to account for interrelations between lifestyle behaviors and cardiovascular disease risk. So far, no systematic review has been conducted. Thus, the aim is to summarize the evidence of associations between lifestyle indices and cardiovascular disease risk in observational prospective studies. EVIDENCE ACQUISITION A systematic literature search was conducted in two databases in February 2018. Multivariable-adjusted risk estimates were combined using random effects models comparing the highest with the lowest healthy lifestyle score. Additionally, meta-analyses for cardiovascular disease types, such as stroke and heart failure, were conducted. Heterogeneity was assessed using I2 index. EVIDENCE SYNTHESIS The search identified 27 studies, of which 22 were included in the meta-analyses. Most lifestyle indices included physical activity, smoking, diet, alcohol consumption, and body weight. A healthy lifestyle was associated with a reduced risk of 66% for cardiovascular disease (95% CI=0.28, 0.41, I2=79.1%), 60% for stroke, and 69% for heart failure. A dose-response effect for adherence to an increasing number of healthy behaviors and cardiovascular disease risk was observed. Statistical heterogeneity was found, suggesting that the definition of the lifestyle indices and components varied substantially between the studies. CONCLUSIONS Adherence to several healthy lifestyle behaviors simultaneously was associated with a 66% reduced cardiovascular disease risk compared with adopting none or only one behavior. Despite heterogeneity of indices, consistent inverse associations across studies underscore the relevance of adopting healthy behaviors at all. More research on other lifestyle behaviors, such as sleep duration or sedentary behavior in combination, is warranted.
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Affiliation(s)
- Janett Barbaresko
- Department of Nutrition and Food Sciences, Group of Nutritional Epidemiology, University of Bonn, North Rhine-Westphalia, Bonn, Germany
| | - Johanna Rienks
- Department of Nutrition and Food Sciences, Group of Nutritional Epidemiology, University of Bonn, North Rhine-Westphalia, Bonn, Germany
| | - Ute Nöthlings
- Department of Nutrition and Food Sciences, Group of Nutritional Epidemiology, University of Bonn, North Rhine-Westphalia, Bonn, Germany.
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25
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Feng Q, Fan S, Wu Y, Zhou D, Zhao R, Liu M, Song Y. Adherence to the dietary approaches to stop hypertension diet and risk of stroke: A meta-analysis of prospective studies. Medicine (Baltimore) 2018; 97:e12450. [PMID: 30235731 PMCID: PMC6160167 DOI: 10.1097/md.0000000000012450] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022] Open
Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower the risk of hypertension, but its role in the prevention of stroke remains in debate. We therefore conducted a meta-analysis to examine the association between DASH diet and incident stroke.A systematic database search in PubMed and Embase was performed to identify eligible prospective studies. The study-specific relative risks (RRs) and 95% confidence intervals (CIs) were pooled using random-effect meta-analysis. Dose-response relationship between DASH diet score and risk of stroke was also assessed.We included 12 prospective cohort studies comprising a total of 548,632 participants, with follow-up duration ranging from 5.7 to 24 years. Compared with lower adherence, higher adherence to the DASH diet was related to a reduced risk of developing stroke (RR 0.88, 95% CI 0.83-0.93). Such a benefit of DASH diet seemed to be greater in the Asian than in the Western populations (P for interaction = .037). Dose-response meta-analysis indicated a linear association of the DASH diet score with stroke (P for nonlinearity = .411), and each 4-points increment in the score conferred a risk reduction of 4% (RR 0.96, 95% CI 0.94-0.97) in total stroke events.Our findings suggest that higher adherence to the DASH diet is associated with a decreased risk of stroke.
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26
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Ma F, Li X, Wang Y, Liang N, Pan S, Yang G, Liao Y, Zhang C, Zhang Q, Lin Y. Effectiveness of traditional Chinese exercises on stroke risk factors in individuals with pre-hypertension or mild-to-moderate essential hypertension: A systematic review and meta-analysis. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2018. [DOI: 10.1016/j.jtcms.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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27
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4566] [Impact Index Per Article: 761.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res 2017; 120:439-448. [PMID: 28154096 DOI: 10.1161/circresaha.116.308413] [Citation(s) in RCA: 1231] [Impact Index Per Article: 175.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/26/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022]
Abstract
On the basis of the GBD (Global Burden of Disease) 2013 Study, this article provides an overview of the global, regional, and country-specific burden of stroke by sex and age groups, including trends in stroke burden from 1990 to 2013, and outlines recommended measures to reduce stroke burden. It shows that although stroke incidence, prevalence, mortality, and disability-adjusted life-years rates tend to decline from 1990 to 2013, the overall stroke burden in terms of absolute number of people affected by, or who remained disabled from, stroke has increased across the globe in both men and women of all ages. This provides a strong argument that "business as usual" for primary stroke prevention is not sufficiently effective. Although prevention of stroke is a complex medical and political issue, there is strong evidence that substantial prevention of stroke is feasible in practice. The need to scale-up the primary prevention actions is urgent.
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Affiliation(s)
- Valery L Feigin
- From the Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (V.L.F.); Department of Clinical Sciences, Neurology, Lund University, Sweden (B.N.); and Division of Cardiovascular Sciences, Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.).
| | - Bo Norrving
- From the Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (V.L.F.); Department of Clinical Sciences, Neurology, Lund University, Sweden (B.N.); and Division of Cardiovascular Sciences, Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - George A Mensah
- From the Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, New Zealand (V.L.F.); Department of Clinical Sciences, Neurology, Lund University, Sweden (B.N.); and Division of Cardiovascular Sciences, Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6145] [Impact Index Per Article: 877.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Metabolic Syndrome and the Risk of Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:286-294. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/20/2016] [Accepted: 09/13/2016] [Indexed: 01/24/2023] Open
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Feigin VL, Norrving B, George MG, Foltz JL, Roth GA, Mensah GA. Prevention of stroke: a strategic global imperative. Nat Rev Neurol 2016; 12:501-12. [PMID: 27448185 PMCID: PMC8114177 DOI: 10.1038/nrneurol.2016.107] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupation Studies, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Drive, Northcote 0627, Private Bag 92006, Auckland 1142, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Paradisgatan 2, Lund, Sweden
| | - Mary G George
- Division for Heart Disease &Stroke Prevention, Centers for Disease Control and Prevention, 600 Clifton Road, Atlanta, Georgia 30333, USA
| | - Jennifer L Foltz
- Division for Heart Disease &Stroke Prevention, Centers for Disease Control and Prevention, 600 Clifton Road, Atlanta, Georgia 30333, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation and the Division of Cardiology, School of Medicine, University of Washington, 2301 5th Avenue Suite 600, Seattle, Washington 98121, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS) and Division of Cardiovascular Sciences; National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892, USA
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Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, Mensah GA, Norrving B, Shiue I, Ng M, Estep K, Cercy K, Murray CJL, Forouzanfar MH. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016; 15:913-924. [PMID: 27291521 DOI: 10.1016/s1474-4422(16)30073-4] [Citation(s) in RCA: 947] [Impact Index Per Article: 118.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The contribution of modifiable risk factors to the increasing global and regional burden of stroke is unclear, but knowledge about this contribution is crucial for informing stroke prevention strategies. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the population-attributable fraction (PAF) of stroke-related disability-adjusted life-years (DALYs) associated with potentially modifiable environmental, occupational, behavioural, physiological, and metabolic risk factors in different age and sex groups worldwide and in high-income countries and low-income and middle-income countries, from 1990 to 2013. METHODS We used data on stroke-related DALYs, risk factors, and PAF from the GBD 2013 Study to estimate the burden of stroke by age and sex (with corresponding 95% uncertainty intervals [UI]) in 188 countries, as measured with stroke-related DALYs in 1990 and 2013. We evaluated attributable DALYs for 17 risk factors (air pollution and environmental, dietary, physical activity, tobacco smoke, and physiological) and six clusters of risk factors by use of three inputs: risk factor exposure, relative risks, and the theoretical minimum risk exposure level. For most risk factors, we synthesised data for exposure with a Bayesian meta-regression method (DisMod-MR) or spatial-temporal Gaussian process regression. We based relative risks on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks, such as high body-mass index (BMI), through other risks, such as high systolic blood pressure (SBP) and high total cholesterol. FINDINGS Globally, 90·5% (95% UI 88·5-92·2) of the stroke burden (as measured in DALYs) was attributable to the modifiable risk factors analysed, including 74·2% (95% UI 70·7-76·7) due to behavioural factors (smoking, poor diet, and low physical activity). Clusters of metabolic factors (high SBP, high BMI, high fasting plasma glucose, high total cholesterol, and low glomerular filtration rate; 72·4%, 95% UI 70·2-73·5) and environmental factors (air pollution and lead exposure; 33·4%, 95% UI 32·4-34·3) were the second and third largest contributors to DALYs. Globally, 29·2% (95% UI 28·2-29·6) of the burden of stroke was attributed to air pollution. Although globally there were no significant differences between sexes in the proportion of stroke burden due to behavioural, environmental, and metabolic risk clusters, in the low-income and middle-income countries, the PAF of behavioural risk clusters in males was greater than in females. The PAF of all risk factors increased from 1990 to 2013 (except for second-hand smoking and household air pollution from solid fuels) and varied significantly between countries. INTERPRETATION Our results suggest that more than 90% of the stroke burden is attributable to modifiable risk factors, and achieving control of behavioural and metabolic risk factors could avert more than three-quarters of the global stroke burden. Air pollution has emerged as a significant contributor to global stroke burden, especially in low-income and middle-income countries, and therefore reducing exposure to air pollution should be one of the main priorities to reduce stroke burden in these countries. FUNDING Bill & Melinda Gates Foundation, American Heart Association, US National Heart, Lung, and Blood Institute, Columbia University, Health Research Council of New Zealand, Brain Research New Zealand Centre of Research Excellence, and National Science Challenge, Ministry of Business, Innovation and Employment of New Zealand.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Sumeet Chugh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kara Estep
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Yang X, Wang A, Liu X, An S, Chen S, Wang Y, Wang Y, Wu S. Positive changes in ideal CVH metrics reduce the incidence of stroke. Sci Rep 2016; 6:19673. [PMID: 26790535 PMCID: PMC4726201 DOI: 10.1038/srep19673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/16/2015] [Indexed: 11/20/2022] Open
Abstract
The American Heart Association defined 7 ideal cardiovascular health (CVH) metrics and the benefits of them in reducing the incidence of stroke are well established, but it is unclear whether changes in them alter stroke risk. We calculated the changes of 7 ideal CVH metrics from 2006 to 2008 among 64,373 participants in the Kailuan study. We tested whether changes in the numbers and total scores for the CVH metrics were associated with the incidence of stroke in the 4.89 person-years follow-up. Cox regression modeling was used to estimate the risk of stroke. By year 2008, CVH metrics number of 32.54% participants improved (change ≥+1); 31.90% deteriorated (≤−1); 35.56% stayed the same; In the follow-up,we identified1,182 incident stroke events. Each increase in CVH metrics and every 1-point increase in total CVH score from 2006 to 2008 were associated with reduced odds of total stroke (hazard ratio = 0.87; 95% confidence interval; 0.83–0.92 and 0.89[0.86–0.92] respectively), after adjusting for age, gender, educational level, income and scores for the metrics of ideal CVH at baseline. Positive changes in ideal CVH metrics reduce the incidence of stroke. Our results support the concept that achieving ideal CVH helps to prevent stroke.
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Affiliation(s)
- Xiaomeng Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan people's Hospital, Tangshan, China
| | - Shasha An
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3744] [Impact Index Per Article: 416.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Norrving B, Davis SM, Feigin VL, Mensah GA, Sacco RL, Varghese C. Stroke Prevention Worldwide--What Could Make It Work? Neuroepidemiology 2015; 45:215-20. [PMID: 26505459 DOI: 10.1159/000441104] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/15/2015] [Indexed: 12/20/2022] Open
Abstract
The global burden of stroke is of continual major importance for global health. The present report addresses some of the core principles that could make stroke prevention work. The prevention of stroke shares many common features with other non-communicable diseases (NCDs); stroke prevention should therefore be part of the joint actions on NCD led by the WHO and member states. Stroke prevention is an integral part of both the 2011 UN declaration on actions on NCDs and the UN Post-2015 Sustainable Developmental Goals. Stroke prevention requires an intersectoral approach, with important responsibilities on the part of governmental bodies, non-government organizations and the health sector as well as communities, industries and individuals. Although official development assistance will need to be provided for the lowest income countries, financing will need to be raised for most countries by reallocation of resources within the country. Stroke is a prototype NCD in that there is overwhelming scientific evidence that with actions taken to reduce risk factors, the risk of stroke can be substantially reduced. Prevention of stroke will also have beneficial effects on cognitive decline and dementia. As most strokes do not lead to death, stroke statistics should not only focus on mortality, but also on disability and quality of life. All preventive actions should start early in life and continue during the life cycle. Prevention of stroke is a complex medical and a political issue with many challenges. Upscaling of efforts to prevent stroke are urgently needed in all regions, and the opportunity to act is now.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
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Zheng YL, Lian F, Shi Q, Zhang C, Chen YW, Zhou YH, He J. Alcohol intake and associated risk of major cardiovascular outcomes in women compared with men: a systematic review and meta-analysis of prospective observational studies. BMC Public Health 2015; 15:773. [PMID: 26264040 PMCID: PMC4533962 DOI: 10.1186/s12889-015-2081-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 07/22/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prevalence of alcohol intake is increasing among women in some populations. Alcohol consumption plays an important role in the risk of major cardiovascular outcomes and total mortality. Here, we conducted a meta-analysis to estimate the association between alcohol intake and major cardiovascular outcomes or total mortality in women compared with men. METHODS We searched the PubMed, Embase, and the Cochrane Library databases for relevant articles published prior to June 2014. Among these potential included prospective studies, the different dose categories of alcohol intake were compared with the lowest alcohol intake or non-drinkers between women and men for the outcomes of major cardiovascular or total mortality. RESULTS We included 23 prospective studies (18 cohorts) reporting data on 489,696 individuals. The summary relative risk ratio (RRR; female to male) for total mortality was significantly increased with moderate alcohol intake compared with the lowest alcohol intake (RRR, 1.10; 95 % confidence interval [CI]: 1.00-1.21; P = 0.047); no such significance was observed with other levels of alcohol intake (low intake: RRR, 1.07; 95 % CI: 0.98-1.17; P = 0.143; heavy intake: RRR, 1.09; 95 % CI: 0.99-1.21; P = 0.084). There was no evidence of a sex difference in the relative risk for coronary disease, cardiac death, stroke, or ischemic stroke between participants with low to heavy alcohol intake compared with those who never consumed alcohol or had the lowest alcohol intake. CONCLUSIONS Women with moderate to heavy alcohol intake had a significantly increased risk of total mortality compared with men in multiple subpopulations. Control of alcohol intake should be considered for women, particularly for young women who may be susceptible to binge drinking.
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Affiliation(s)
- Yan-Ling Zheng
- Department of Teaching Affairs and Scientific Research, Shandong Medical College, Jinan, Shandong, China.
| | - Feng Lian
- Department of Ultrasonography, Shanghai Seventh People's Hospital, Shanghai, China.
| | - Qian Shi
- Department of Ultrasonography, Shanghai Seventh People's Hospital, Shanghai, China.
| | - Chi Zhang
- Department of Neurosurgery, Shanghai Seventh People's Hospital, Shanghai, China.
| | - Yi-Wei Chen
- Department of Rehabilitation Institute, Shanghai Seventh People's Hospital, Shanghai, China.
| | - Yu-Hao Zhou
- Department of Rehabilitation Institute, Shanghai Seventh People's Hospital, Shanghai, China.
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China.
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Helbig AK, Stöckl D, Heier M, Ladwig KH, Meisinger C. Symptoms of Insomnia and Sleep Duration and Their Association with Incident Strokes: Findings from the Population-Based MONICA/KORA Augsburg Cohort Study. PLoS One 2015; 10:e0134480. [PMID: 26230576 PMCID: PMC4521822 DOI: 10.1371/journal.pone.0134480] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022] Open
Abstract
Objective To examine the relationship between symptoms of insomnia and sleep duration and incident total (non-fatal plus fatal) strokes, non-fatal strokes, and fatal strokes in a large cohort of men and women from the general population in Germany. Methods In four population-based MONICA (monitoring trends and determinants in cardiovascular disease)/KORA (Cooperative Health Research in the Region of Augsburg) surveys conducted between 1984 and 2001, 17,604 men and women (aged 25 to 74 years) were asked about issues like sleep, health behavior, and medical history. In subsequent surveys and mortality follow-ups, incident stroke cases (cerebral hemorrhage, ischemic stroke, transient ischemic attack, unknown stroke type) were gathered prospectively until 2009. Sex-specific hazard ratios (HR) and their 95% confidence intervals (CI) were estimated using sequential Cox proportional hazards regression models. Results During a mean follow-up of 14 years, 917 strokes (710 non-fatal strokes and 207 fatal strokes) were observed. Trouble falling asleep and difficulty staying asleep were not significantly related to any incident stroke outcome in either sex in the multivariable models. Among men, the HR for the association between short (≤5 hours) and long (≥10 hours) daily sleep duration and total strokes were 1.44 (95% CI: 1.01–2.06) and 1.63 (95% CI: 1.16–2.29), after adjustment for basic confounding variables. As for non-fatal strokes and fatal strokes, in the analyses adjusted for age, survey, education, physical activity, alcohol consumption, smoking habits, body mass index, hypertension, diabetes, and dyslipidemia, the increased risks persisted, albeit somewhat attenuated, but no longer remained significant. Among women, in the multivariable analyses the quantity of sleep was also not related to any stroke outcome. Conclusion In the present study, symptoms of insomnia and exceptional sleep duration were not significantly predictive of incident total strokes, non-fatal strokes, and fatal strokes in either sex.
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Affiliation(s)
- A Katharina Helbig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Doris Stöckl
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Howard VJ, McDonnell MN. Physical Activity in Primary Stroke Prevention. Stroke 2015; 46:1735-9. [DOI: 10.1161/strokeaha.115.006317] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/17/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Virginia J. Howard
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); and Division of Health Sciences, International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, Australia (M.N.M.)
| | - Michelle N. McDonnell
- From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); and Division of Health Sciences, International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, Australia (M.N.M.)
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Barlinn K, Kepplinger J, Puetz V, Illigens BM, Bodechtel U, Siepmann T. Exploring the risk-factor association between depression and incident stroke: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2015; 11:1-14. [PMID: 25565846 PMCID: PMC4274141 DOI: 10.2147/ndt.s63904] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
There is growing evidence that depression increases the risk of incident stroke. However, few studies have considered possible residual confounding effects by preexistent cerebrovascular and cardiac diseases. Therefore, we synthesized data from cohort studies to explore whether depressed individuals free of cerebrovascular and cardiac diseases are at higher risk of incident stroke. We searched the electronic databases PubMed and Medline for eligible cohort studies that examined the prospective association between depression and first-ever stroke. A random-effects model was used for quantitative data synthesis. Sensitivity analyses comprised cohort studies that considered a lag period with exclusion of incident strokes in the first years of follow-up to minimize residual confounding by preexistent silent strokes and excluded cardiac disease at baseline. Overall, we identified 28 cohort studies with 681,139 participants and 13,436 (1.97%) incident stroke cases. The pooled risk estimate revealed an increased risk of incident stroke for depression (relative risk 1.40, 95% confidence interval [CI] 1.27-1.53; P<0.0001). When we excluded incident strokes that occurred in the first years of follow-up, the prospective association between depression and incident stroke remained significant (relative risk 1.64, 95% CI 1.27-2.11; P<0.0001). This positive association also remained after we considered only studies with individuals with cardiac disease at baseline excluded (relative risk 1.43, 95% CI 1.19-1.72; P<0.0001). The prospective association of depression and increased risk of first-ever stroke demonstrated in this meta-analysis appears to be driven neither by preexistence of clinically apparent cerebrovascular and cardiovascular diseases nor by silent stroke.
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Affiliation(s)
- Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Jessica Kepplinger
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ulf Bodechtel
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
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