Frequency and etiological diagnosis of ischemic stroke in Chinese young adults

Methodological, reporting, and evidence quality of systematic reviews of traditional Chinese medicine for ischemic stroke

Objective: The aim of this study is to critically appraise whether published systematic reviews/meta-analyses of traditional Chinese medicine for adults with ischemic stroke are of sufficient quality and to rate the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Method: A literature search was performed in the Cochrane Library, PubMed, Chinese National Knowledge Infrastructure, and SinoMed databases by March 2022. The inclusion criteria were systematic reviews/meta-analyses of traditional Chinese medicine in adults who suffered from ischemic stroke. A Measurement Tool to Access Systematic Reviews 2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Abstract (PRISMA-A) statements were used to assess the methodological and reporting quality of the included reviews. The Grading of Recommendations, Assessment, Development, and Evaluation system was utilized to assess each report's evidence level. Results: Of the 1,908 titles and abstracts, 83 reviews met the inclusion criteria. These studies were published between 2005 and 2022. The results of AMSTAR-2 showed that 51.4% of the items were reported, but the registration, reasons for the inclusion of study design, the list of excluded studies, and funding information were ignored in the majority of the reviews. The results of PRISMA-A showed that 33.9% of items were reported, and the information on registration, limitation, and funding was not available in many publications. The assessment of the evidence with the Grading of Recommendations, Assessment, Development, and Evaluation showed that more than half (52/83) of the included studies had either low or very low levels of evidence. Conclusion: The reporting quality in the abstract of systematic reviews/meta-analyses on traditional Chinese medicine for ischemic stroke is poor and does not facilitate timely access to valid information for clinical practitioners. Although the methodological quality is of a medium level, this evidence lacks certainty, especially with a high risk of bias in individual studies.

Ascertainment of Alaska Native Stroke Incidence, 2005-2009: Lessons for Assessing the Global Burden of Stroke

BACKGROUND

Stroke is a critical public health issue in the United States and globally. System models to optimally capture stroke incidence in rural and culturally diverse communities are needed. The epidemiological transition to a western lifestyle has been associated with an increased burden of vascular risk factors among Alaska Native (AN) people. The burden of stroke in AN communities remains understudied.

METHODS

The Alaska Native Stroke Registry (ANSR) was designed to screen and capture all stroke cases between 2005 and 2009 through its integration into the existing single-payer Alaska Tribal Health System infrastructure. Registry staff received notification each time stroke International Classification of Diseases, Ninth Revision codes (430-436) were initiated anywhere in the system. Trained chart abstractors reviewed medical records to document incident strokes among AN patients, which were adjudicated.

RESULTS

Between October 2005 and October 2009, over 2100 alerts were screened identifying 514 unique stroke cases, of which 372 were incident strokes. The average annual incidence of stroke (per 100,000) among AN adults was 190.6: 219.2 in men and 164.7 in women. Overall, the ischemic stroke incidence rate was 148.5 per 100,000 with men (184.6) having higher ischemic rates per 100,000 than women (118.3). Men have higher rates of ischemic stroke at all ages, whereas older women experienced higher rates of hemorrhagic strokes over the age of 75 years.

CONCLUSIONS

We report a high rate of overall stroke, 190.6 per 100,000. The ANSR methods and findings have implications for other indigenous populations and for global health populations currently undergoing similar epidemiological transitions.

Association between polyvascular atherosclerosis and estimated glomerular filtration rate in patients with ischaemic stroke: data analysis of the patients in the Chinese National Stroke Registry

OBJECTIVES

This study evaluated the prevalence of chronic kidney disease (CKD) in ischemic stroke (IS) patients with polyvascular disease (PolyVD) and analysed the relationship between PolyVD and estimated glomerular filtration rate (eGFR) in IS patients.

METHODS

Data from 9152 consecutive IS patients from the China National Stroke Registry were analysed. PolyVD was defined as patients with IS and coronary artery disease (CAD) and/or peripheral arterial disease (PAD). Chronic kidney disease was defined as eGFR < 60 mL/minute/1.73 m(2).The prevalence of CKD in IS patients with PolyVD was calculated. Logistic regression was used to estimate the correlation between PolyVD and eGFR between the monovascular group (IS alone) and the PolyVD group after adjusting for age, current or previous smoking, moderate or heavy drinking, body mass index, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, previous stroke, and National Institutes of Health Stroke Scale scores.

RESULTS

PolyVD was observed in 1387 of 9152 patients (15.16%). Among these patients, 1351 (14.76%) had CAD, 56 (0.61%) had PAD, and 20 (0.22%) had CAD and PAD in addition to IS. The prevalence of CKD in IS patients with PolyVD and IS alone was 29.56 and 16.28%, respectively (P < 0.0001). The PolyVD group had a significantly higher risk of lower eGFR (OR: 1.414, 95% CI: 1.202-1.665, P < 0.0001) compared with patients with IS alone.

DISCUSSION

IS patients with PolyVD had a high prevalence of CKD, and PolyVD was independently associated with a low eGFR.