Xu 2006
Xu 2006
Xu 2006
Key Words Stroke recurrence and its predictors have rarely been
Stroke recurrence Hypertension Stroke risk determinants investigated in China. Stroke prevention and manage-
Atrial fibrillation Smoking ment guidelines designed for Chinese were tailored to a
considerable degree on the basis of epidemiological, etio-
logical and clinical profiles mirrored from western popu-
Abstract lations. But previous studies of stroke incidence and re-
Background: Data concerning stroke occurrence and recur- currence discovered significant variances across coun-
rence in China are extremely rare. This study was designed tries of different socioeconomic backgrounds and among
to analyze determinants of stroke recurrence in a cohort of populations of different ethnic origins [1, 2]. These vari-
Chinese patients. Methods: Subjects were patients with ances emphasize the need for population-specific preven-
ischemic stroke registered in the Nanjing Stroke Registry tive strategies on account of influence factors for stroke
Program. Modifiable risk factors for stroke were identified occurrence and recurrence. Based on the data bank of the
and stratified into 3 levels: without, controlled and uncon- first stroke registry program in mainland China, we in-
trolled. Cox proportional hazard model was used to detect vestigated in this study the 1st-year recurrence and risk
influence factors for stroke recurrence. Results: First-year re- determinants in a cohort of Chinese stroke patients.
currence rate was 11.2% in the registered patients. Hyper-
tension, atrial fibrillation (AF) and smoking were associated
with increased risk of recurrence. Controlling hypertension Subjects and Methods
and AF each halved recurrent risk (p ! 0.001). Ceasing smok-
Subjects were patients registered in the Nanjing Stroke Regis-
ing for more than 1 year reduced hazard ratio of recurrence
try Program (NSRP). The detailed protocol for the NSRP has been
from 1.71 to 1.39 (p ! 0.05). Controlling blood sugar level in published previously [3]. All patients registered in the NSRP were
diabetics did not significantly change recurrent risk (hazard evaluated for eligibility for enrollment. Inclusion criteria includ-
ratio, 1.69 vs. 1.64, p 1 0.05). Conclusions: The recurrence ed having first-ever ischemic stroke, being evaluated by a neu-
rate is higher in Chinese patients with ischemic stroke com- rologist within 7 days of stroke onset, having at least one CT or
MRI scan during hospitalization, being aged 18 years or older.
pared with the one reported in western populations. Failure
Because status of risk factor controlling in patients who died of
to control some modifiable risk factors in Chinese patients index stroke was mostly unknown, they were excluded from data
may be responsible for this discrepancy. analysis. This study was approved by the Ethical Review Board of
Copyright © 2007 S. Karger AG, Basel Jinling Hospital.
Subtype of stroke
Lacunar 1.00 0.001
Atherothrombolic 3.24 (1.78–5.92)
Cardioembolic 2.55 (1.35–4.82)
Undetermined 3.18 (1.74–5.81)
Hypertension
Without 1.00 0.000
Controlled 1.54 (1.05–2.24)
Uncontrolled 3.15 (2.15–4.62)
DM
Without 1.00 0.011
Controlled 1.64 (1.10–2.45)
Uncontrolled 1.69 (1.06–2.68)
AF
Without 1.00 0.000
Controlled 2.38 (1.39–4.08)
Uncontrolled 4.70 (2.96–7.46)
History of TIA
Without 1.00 0.023
With 1.59 (1.07–2.38)
Smoking
Nonsmoker 1.00 0.015
Former smoker 1.39 (0.92–2.11)
Current smoker 1.71 (1.18–2.47)
Antiplatelet treatment
With 1.00 0.036
Without 1.41 (1.02–1.94)
Discussion
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