Do Cardiometabolic Risk Factors Relative Risks Differ for the Occurrence of Ischemic Heart Disease and Stroke?

Dose-Response Association Between High-Density Lipoprotein Cholesterol and Stroke: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

INTRODUCTION

Studies investigating the effect of high-density lipoprotein cholesterol (HDL-C) on stroke and stroke subtypes have reached inconsistent conclusions. The purpose of our study was to clarify the dose-response association between HDL-C level and risk of total stroke and stroke subtypes by a systematic review and meta-analysis.

METHODS

We performed a systematic search of PubMed, Embase, and Web of Science databases through July 30, 2020, for prospective cohort studies that reported the HDL-C-stroke association and extracted the estimate that was adjusted for the greatest number of confounding factors. Restricted cubic splines were used to evaluate the linear and nonlinear dose-response associations.

RESULTS

We included 29 articles, which reported on 62 prospective cohort studies including 900,501 study participants and 25,678 with stroke. The summary relative risk per 1-mmol/L increase in HDL-C level for total stroke was 0.82 (95% CI, 0.76-0.89; I² = 42.9%; n = 18); ischemic stroke (IS), 0.75 (95% CI, 0.69-0.82; I² = 50.1%; n = 22); intracerebral hemorrhage (ICH), 1.21 (95% CI, 1.04-1.42; I² = 33.4%; n = 10); and subarachnoid hemorrhage (SAH), 0.98 (95% CI, 0.96-1.00; I² = 0%; n = 7). We found a linear inverse association between HDL-C level and risk of total stroke and SAH, a nonlinear inverse association for IS risk, but a linear positive association for ICH risk. The strength and the direction of the effect size estimate for total stroke, IS, ICH, and SAH remained stable for most subgroups. We found no publication bias with Begg's test and Egger's test for the association of HDL-C level with risk of total stroke, IS, and ICH.

CONCLUSION

A high HDL-C level is associated with reduced risk of total stroke and IS and an increased risk of ICH.

The prevalence of metabolic syndrome in cardiovascular patients in Iran: a systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is the cause of more than 50% of mortalities globally, and this rate has grown by 8.6% since the 60 s. One of the risk factors associated with cardiovascular disease and its resulting mortality rate is the metabolic syndrome. Different studies have reported inconsistent rates for the metabolic syndrome. However, no comprehensive study has been conducted to combine the results of existing studies. Thus, the present study was performed with the aim of determining the prevalence of metabolic syndrome among cardiovascular patients in Iran through a systematic review and meta-analysis.

METHOD

In this review study, the Scientific Information Database, Google Scholar, Science Direct, Scopus, PubMed, and Web of Science (ISI), databases were searched from January 2005 and until May 2020, to identify and extract related articles. To conduct the analysis, a random effects model was used, and the heterogeneity of the studies was examined using the I² index. Data analysis was performed within Comprehensive Meta-Analysis (version 2) software.

RESULTS

The prevalence of metabolic syndrome in cardiovascular patients in Iran in the 27 papers examined with a sample size of 44,735 patients was 34.2% (95% CI: 26.8-42.6%). A sensitivity analysis was performed to ensure the stability of the results, these results show that by omitting the prevalence from each study, the overall prevalence (34.2%) does not change significantly. the highest prevalence of metabolic syndrome in studies conducted in the period between 2015 and 2020, and this was reported as 55.3 (95% CI: 47.9-62.3) and the highest prevalence of metabolic syndrome in studies conducted in the methods of diagnosis IDF, and the rate was reported as 48 (95% CI: 36.5-59.8). based on meta-regression as the year of research increased, the prevalence of metabolic syndrome in cardiovascular patients in Iran also increased. However, with the increase in sample size, this prevalence decreased (p < 0.05).

CONCLUSIONS

The results of this study indicate that metabolic syndrome is high in cardiovascular patients in Iran. Accordingly, by understanding its etiology and supervision at all levels, suitable solutions could be offered by providing feedback to hospitals.

Burden of Ischaemic heart disease and attributable risk factors in China from 1990 to 2015: findings from the global burden of disease 2015 study

BACKGROUND

Ischaemic heart disease (IHD) is a major barrier to sustainable human development, but its health burden and geographic distribution among provinces of China remain unclear. This study aimed to estimate IHD burden in provinces of China, and attributable to risk factors from 1990 to 2015.

METHODS

Data were collected from the Global Burden of Disease 2015 Study, which evaluated IHD burden and attributable risk factors using deaths and disability-adjusted life years (DALYs). Statistical models including cause of death ensemble modelling, Bayesian meta-regression analysis, and comparative risk assessment approaches were applied to reduce bias and produce comprehensive results of IHD deaths, DALYs and attributable risks. The 95% uncertainty intervals (UIs) were calculated and reported for mortality and DALYs.

RESULTS

The age-standardised death rate per 100,000 people increased by 13.3% from 101.3 (95%UI: 95.3-107.5) to 114.8 (95%UI: 109.8-120.1) from 1990 to 2015 in China, whereas the age-standardised DALY rate declined 3.9% to 1760.2 per 100,000 people (95%UI: 1671.6-1864.3). In 2015, the age-standardised death rate per 100,000 people was the highest in Heilongjiang (187.4, 95%UI: 161.6-217.5) and the lowest in Shanghai (44.2, 95%UI: 37.0-53.1), and the age-standardised DALY rate per 100,000 people was the highest in Xinjiang (3040.8, 95%UI: 2488.8-3735.4) and the lowest in Shanghai (524.4, 95%UI: 434.7-638.4). Geographically, the age-standardised death and DALY rates for southern provinces were lower than northern provinces, especially in southeastern coastal provinces. 95.3% of the IHD burden in China was attributable to environmental, behavioural and metabolic risk factors. The five leading IHD risks in 2015 were high systolic blood pressure, high total cholesterol, diet high in sodium, diet low in whole grains, and smoking.

CONCLUSIONS

Population growth and ageing has led to a steady increase in the IHD burden. Regional disparities in IHD burden were observed in provinces of China. The distribution characteristics of IHD burden provide guidance for decision makers to formulate targeted preventive policies and interventions.

The evaluation of left ventricular diastolic dysfunction in patients with non-hemorrhagic stroke and atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) is the most common tachyarrhythmia and an important risk factor for thromboembolic stroke. CHA2DS2-VASc score was introduced for assessment of embolic events and as criteria for starting anticoagulants. This study was performed to evaluate the left ventricular diastolic dysfunction (LVDD) in patients with non-hemorrhagic stroke and AF.

METHODS

This cross-sectional study consisted of 76 consecutive patients with suspected non-hemorrhagic stroke referred to the Cardiology Department of Alzahra and Ayatollah Kashani hospitals in Isfahan, Iran, during 2015-2016. Demographic, anthropometric and clinical characteristics were evaluated for all patients at baseline. CHA2DS2-VASc score was calculated for all. All eligible patients underwent transthoracic echocardiogram (TTE) and LVDD was measured in the patients.

RESULTS

The mean age of the patients was 64.64 ± 5.95 years and 28 subjects (36.8%) were women. The most common underlying disease in the patients was hypertension (HTN) (65.8%). Median (range) CHA2DS2-VASc score was 4 (1-7). Four patients (5.3%) had paroxysmal AF and 16 cases (21.1%) had LVDD. Analysis showed that LVDD in patients with non-hemorrhagic stroke and coexisting AF was not associated with CHA2DS2-VASc score (r = 0.151, P = 0.192).

CONCLUSION

LVDD is not associated with CHA2DS2-VASc score in patients with non-hemorrhagic stroke and coexisting AF.

Stroke screening and health-related physical fitness testing in medical staff members in Urumqi, China

Objective

Stroke is the leading cause of death and disability, and is closely related to a lack of exercise. Currently, most Chinese medical staff members lack exercise and may be at risk for stroke. We sought to determine the risk factors for stroke and study the significance of health-related physical fitness testing in stroke prevention among Chinese medical staff members.

Methods

A total of 627 subjects from Urumqi, Xinjiang, China, were included in the study and a survey was conducted from 1st January 2016 to 1st February 2016. Stroke screening and health-related physical fitness testing were completed according to the standard protocol, and the related data were analyzed.

Results

Based on the screening, 27.6% (n = 173) of the subjects were at high risk for stroke. The top risk factors for stroke in these subjects were dyslipidemia, lack of exercise or mild physical activity, being overweight or obese, and high blood pressure. Body weight, body mass index, body fat, visceral fat area, body fat percentage, and basal metabolic rate were significantly higher (P < 0.01) in subjects at high risk for stroke than in subjects who were not at high risk. Lung capacity, step index, grip test, vertical jump, and sit-up/push-up index were significantly lower (P < 0.01) in subjects at high risk for stroke than in subjects who were not at high risk.

Conclusions

A large proportion of China's on-the-job medical personnel is at high risk for stroke. This may be related to the nature of the profession and warrants more attention from the society. The health-related physical fitness measurement parameters in subjects at high risk for stroke were significantly different from those in subjects who were not at high risk. Screening and health-related physical fitness testing in medical staff members may contribute to stroke prevention. More rigorous controlled clinical trials will be needed in the future.