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Chi X, Zhang N, Fan F, Jia J, Zheng J, Liu L, Song Y, Wang B, Tang G, Qin X, Huo Y, Li J. Systemic immune-inflammation index predicts first stroke and affects the efficacy of folic acid in stroke prevention. Heliyon 2024; 10:e24837. [PMID: 38314266 PMCID: PMC10837552 DOI: 10.1016/j.heliyon.2024.e24837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Background Systemic immune-inflammation index (SII) is a novel biomarker of growing interest in predicting stroke. The aim of this study was to investigate its predictive value and explore its effect modification on folic acid supplement for stroke primary prevention in a Chinese population with hypertension. Methods A total of 10,013 participants from the China Stroke Primary Prevention Trial with available neutrophil, platelet and lymphocyte count were included, including 5,019 subjects in the enalapril group and 4,994 in the enalapril-folic acid group. SII was calculated as (platelet × neutrophil)/lymphocyte. The primary endpoint was first stroke. Cox proportional hazards models were used to evaluate the association between SII and first stroke. Results A U-shape association between SII and first stroke risk was observed in enalapril group. Compared with the reference group (Quartile 2: 335.1 to <443.9 × 109 cell/L), the adjusted HRs were 1.68 (95 % CI: 1.06-2.66, P = 0.027) in Quartile 1 (<335.1 × 109 cell/L), 1.43 (95 % CI: 0.90-2.27, P = 0.126) in Quartile 3 (443.9 to <602.6 × 109 cell/L), and 1.61 (95 % CI: 1.03-2.51, P = 0.035) in Quartile 4 (≥602.6 × 109 cell/L). There was no significant association between SII and first stroke in the enalapril-folic acid group, with adjusted HR of 0.92 (95%CI: 0.54-1.56, P = 0.749) in Quartile 1(<334.7 × 109 cell/L), 1.36 (95%CI: 0.84-2.21, P = 0.208) in Quartile 3 (446.2 to <595.2 × 109 cell/L), and 1.41 (95%CI: 0.87-2.27, P = 0.163) in Quartile 4 (≥595.2 × 109 cell/L). A remarkable interaction between baseline SII and folic acid supplement for stroke prevention was observed, with particularly reduced risk by 44 % (HR: 0.56; 95 % CI: 0.34-0.90; P = 0.018) in the lowest SII group (P for interaction = 0.041). Conclusions Among Chinese adults with hypertension, both low and high SII at baseline predicted increased first stroke risk. And compensatory folic acid particularly reduced first stroke risk in the lowest SII subgroup.
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Affiliation(s)
- Xiying Chi
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Nan Zhang
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jianhang Zheng
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Lishun Liu
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
- Shenzhen Evergreen Medical Institute, Shenzhen, China
| | - Yun Song
- Shenzhen Evergreen Medical Institute, Shenzhen, China
- Institute for Biomedicine, Anhui Medical University, Hefei, China
- AUSA Research Institute, Shenzhen AUSA Pharmed Co Ltd, Shenzhen, China
| | - Binyan Wang
- Institute for Biomedicine, Anhui Medical University, Hefei, China
| | - Genfu Tang
- School of Health Administration, Anhui Medical University, Hefei, 230000, China
| | - Xianhui Qin
- National Clinical Research Study Center for Kidney Disease, The State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
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He P, Yang Y, Tian J, Yang M, Lin Z, Li H, Zhang Y, Liu M, Zhou C, Zhang Z, Li Y, Zhang Y, Li J, Huo Y, Xu X, Qin X, Liang M. Urinary albumin-to-creatinine ratio and the risk of first stroke in Chinese hypertensive patients treated with angiotensin-converting enzyme inhibitors. Hypertens Res 2021. [PMID: 34645988 DOI: 10.1038/s41440-021-00780-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/29/2021] [Accepted: 08/28/2021] [Indexed: 11/08/2022]
Abstract
We aimed to evaluate the relationship of the albumin-to-creatinine ratio (ACR) with the risk of first stroke and examine possible effect modifiers in hypertensive patients. A total of 11,632 hypertensive participants with urinary ACR measurements and without a history of stroke from the China Stroke Primary Prevention Trial (CSPPT) were included in this analysis. The primary outcome was first stroke. Over a median follow-up of 4.4 years, 728 first strokes were identified, of which 633 were ischemic, 89 were hemorrhagic, and 6 were uncertain types. Overall, there was a significant positive association between natural log-transformed ACR and the risk of first stroke (HR, 1.11; 95% CI: 1.03-1.20) and first ischemic stroke (HR, 1.12; 95% CI: 1.03-1.22). Consistently, participants with ACR ≥ 10 mg/g had a significantly higher risk of first stroke (HR, 1.26; 95% CI: 1.06-1.50) and first ischemic stroke (HR, 1.33; 95% CI: 1.10-1.59) than those with ACR < 10 mg/g. Moreover, the association of ACR with first stroke was significantly stronger in participants with higher total homocysteine (tHcy) levels (<10 versus ≥ 10 μmol/L; P for interaction = 0.044). However, there was no significant association between ACR and first hemorrhagic stroke (per natural log [ACR] increment: HR, 1.02; 95% CI: 0.82-1.27). In summary, hypertensive patients with ACR ≥ 10 mg/g had a significantly increased risk of first stroke or first ischemic stroke. This positive association was more pronounced among participants with higher tHcy levels.
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Hu H, Bi C, Lin T, Liu L, Song Y, Wang B, Wang P, Zhou Z, Fang C, Ma H, Huang X, Hu L, Xu X, Zhang H, Huo Y, Wang X, Bao H, Cheng X, Li P. Sex difference in the association between plasma selenium and first stroke: a community-based nested case-control study. Biol Sex Differ 2021; 12:39. [PMID: 34051856 PMCID: PMC8164764 DOI: 10.1186/s13293-021-00383-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To date, there is no clearly defined association between plasma selenium levels and first stroke. We aimed to investigate the association between baseline plasma selenium and first stroke risk in a community-based Chinese population. METHODS Using a nested case-control study design, a total of 1255 first stroke cases and 1255 matched controls were analyzed. Participant plasma selenium concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS), and the association of plasma selenium with first stroke risk was estimated by conditional logistic regression models. RESULTS Overall, a non-linear negative association between plasma selenium and first total stroke and first ischemic stroke risks was found in males but not in females. Compared with participants with lower selenium levels (tertile 1-2, < 94.1 ng/mL), participants with higher selenium levels (tertile 3, ≥ 94.1 ng/mL) had significantly lower risks of first total stroke (OR 0.63; 95% CI 0.48, 0.83) and first ischemic stroke (OR 0.61; 95% CI 0.45, 0.83) in males but not in females with first total stroke (OR 0.92; 95% CI 0.69, 1.22) and first ischemic stroke (OR 0.89; 95% CI 0.65, 1.22). Furthermore, a stronger association between plasma selenium and first total stroke was found in males with higher vitamin E levels (≥ 13.5 μg/mL vs. < 13.5 μg/mL P-interaction = 0.007). No significant association was observed between plasma selenium and first hemorrhagic stroke risk in either males or females. CONCLUSION Our study indicated a significant, non-linear, negative association between plasma selenium and first stroke in males but not in females. TRIAL REGISTRATION ChiCTR1800017274 .
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Affiliation(s)
- Huan Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, No. 1 Minde Road, Nanchang, Jiangxi Province, China
| | - Chonglei Bi
- People's Hospital of Rongcheng, No. 298 Chengshan Avenue, Rongcheng, Shandong Province, China
| | - Tengfei Lin
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
| | - Lishun Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
- Institute of Biomedicine, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui Province, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui Province, China
- Shenzhen Evergreen Medical Institute, No. 16 Gaoxin Middle 1 Road, Shenzhen, China
| | - Ping Wang
- School of Public Health (Shenzhen), Sun Yat-Sen University, No. 135 Xingang West Road, Guangzhou, Guangdong Province, China
| | - Ziyi Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
| | - Chongqian Fang
- People's Hospital of Rongcheng, No. 298 Chengshan Avenue, Rongcheng, Shandong Province, China
| | - Hai Ma
- Health and Family Planning Commission, No. 688 Qingshan East Road, Rongcheng, Shandong Province, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, No. 1 Minde Road, Nanchang, Jiangxi Province, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, China
| | - Xiping Xu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
| | - Hao Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Tsinghua East Road, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 3400 N. Charles Street, Baltimore, MD, 21205, USA
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, No. 1 Minde Road, Nanchang, Jiangxi Province, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, No. 1 Minde Road, Nanchang, Jiangxi Province, China
| | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China.
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, No. 1 Minde Road, Nanchang, Jiangxi Province, China.
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Edzie EKM, Gorleku PN, Dzefi-Tettey K, Idun EA, Amankwa AT, Aidoo E, Asemah AR, Kusodzi H. Incidence rate and age of onset of first stroke from CT scan examinations in Cape Coast metropolis. Heliyon 2021; 7:e06214. [PMID: 33659742 PMCID: PMC7892921 DOI: 10.1016/j.heliyon.2021.e06214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The trends in the incidence and age of onset of first stroke is lacking in Ghana and with an increasing elderly population, such trends are projected to increase in developing countries. Through the review of Computed Tomography (CT) scan examinations and patients’ records; we assessed the incidence rate and age of onset of first stroke in Cape Coast Metropolis. Methods This study retrospectively reviewed all imaging records and clinical data of all stroke patients referred for CT scans in the radiology department of the Cape Coast Teaching Hospital (CCTH) between January 2017 and December 2019. All CT confirmed cases of stroke were classified as either hemorrhagic stroke or ischemic stroke. Age adjusted annual incidence rate with 95% Confidence Intervals (CIs) were calculated assuming a Poisson distribution. Mean difference were tested using one way Analysis of Variance (ANOVA). Results 840 patients with first onset of stroke were identified, comprising 417 (49.6%) males and 423 (50.4%) females. There was a statistically significant difference in the mean age of onset of first stroke in males (61.47 ± 13.36 years) and in females (63.41 ± 15.41 years), p = 0.049. The incidence of first stroke for the entire age categories were higher in males compared to the same age categories in females, except for patients aged 35–44 years in 2017, 25–34 years in 2018, 15–24 years and 75 years or older age groups in 2019. Males had hemorrhagic stroke at an older age (64.41 ± 15.31 years) compared to ischemic stroke (60.40 ± 12.42 years) in this study. This difference was statistically significant (p = 0.014). There was no significant difference in the mean age of onset of first stroke for the respective years under study: F (3, 836) = 0.693, P = 0.500. Conclusion The findings of this study imply that the incidence rate of stroke is higher in males than in females and increases with age. The majority of the strokes were ischemic.
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Affiliation(s)
- Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Philip Narteh Gorleku
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Klenam Dzefi-Tettey
- Department of Radiology. Korle Bu Teaching Hospital. 1 Guggisberg Avenue, Accra, Ghana
| | - Ewurama Andam Idun
- Department of Radiology, 37 Military Hospital, Neghelli Barracks Liberation Road 37, Accra, Ghana
| | - Adu Tutu Amankwa
- Department of Radiology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Aidoo
- Department of Anatomy, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Zhang Z, Zhou C, Liu M, Zhang Y, Li H, He P, Nie J, Liang M, Liu C, Song Y, Liu L, Wang B, Zhang Y, Li J, Huo Y, Wang X, Xu X, Qin X. Neutrophil counts and the risk of first stroke in general hypertensive adults. Hypertens Res 2021; 44:830-9. [PMID: 33564178 DOI: 10.1038/s41440-021-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022]
Abstract
We aimed to investigate the association between neutrophil counts and first stroke and examine possible effect modifiers among treated hypertensive adults. This is a post hoc analysis of the China Stroke Primary Prevention Trial (CSPPT). A total of 11,878 hypertensive adults with data on neutrophil counts at baseline were included in the current study. The primary outcome was first stroke. During a median follow-up of 4.5 years, 414 (3.5%) participants experienced a first stroke, including 358 with ischemic stroke, 55 with hemorrhagic stroke and one with uncertain type of stroke. Compared with participants in quartile 1 (<2.9 × 109/L) of neutrophil counts, those in the upper quartiles (quartile 2-4 [≥2.9 × 109/L]) had a significantly higher risk of first stroke (HR, 1.35; 95% CI: 1.02, 1.78) or first ischemic stroke (HR, 1.38; 95% CI: 1.02, 1.86). Moreover, a strong positive association between neutrophil counts and first ischemic stroke was found in participants with total homocysteine (tHcy) levels <15 μmol/L (HR, 1.74; 95% CI: 1.17, 2.58; vs. ≥15 μmol/L; HR, 0.91; 95% CI: 0.57, 1.46, P interaction = 0.042) at baseline or time-averaged mean arterial pressure (MAP) ≥102 mmHg (median) (HR, 1.92; 95% CI: 1.27, 2.89; vs. <102 mmHg; HR, 0.89; 95% CI: 0.57, 1.41, P interaction = 0.015) during the treatment period. However, no such association between neutrophil counts and first hemorrhagic stroke was found. In summary, high baseline neutrophil counts were associated with an increased risk of first ischemic stroke among hypertensive patients, especially in those with low tHcy at baseline or high time-averaged MAP during the treatment period.
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