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Journal of Neurology

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01-05-2019 | Stroke | Original Communication

Lifestyles correlate with stroke recurrence in Chinese inpatients with first-ever acute ischemic stroke

Authors: Zhi-Xin Huang, Xiao-Ling Lin, Hai-Ke Lu, Xiao-Yu Liang, Li-Juan Fan, Xin-Tong Liu

Published in: Journal of Neurology | Issue 5/2019

Abstract

Objectives

The previous studies have shown that recurrent stroke (RS) adversely affects the life of survivors of ischemic stroke (IS). However, lifestyle associated with RS has received a little systematic study in Chinese Han patients. We aimed to perform a comprehensive assessment of lifestyle and the potential risk factors associated with RS in Chinese Han inpatients with first-ever acute ischemic stroke by conducting a long-term follow-up.

Methods

Using a prospective and longitudinal design, we recruited 421 patients with first-ever acute ischemic stroke who were consecutively admitted to the Acute Stroke Unit between November 2012 and January 2014. Demographic data, vascular risk factors, previous Rankin scale score, and etiology were collected at study intake. Multivariable Cox regression model was used to investigate the influencing factors for RS.

Results

Fifty-seven (13.5%) patients experienced RS during the 1-year follow-up period. Multivariable Cox regression analysis revealed that smoking [hazard ratio (HR), 2.153; 95% confidence interval (CI), 1.263–3.671], high-density lipoprotein cholesterol (HDL) (HR 0.438; 95% CI 0.211–0.911), housework (HR 0.488; 95% CI 0.256–0.933), ischemic heart disease (IHD) (HR 2.998; 95% CI 1.281–7.020), daily consumption of fresh fruits (HR 0.477; 95% CI 0.278–0.819), and good sleep quality (HR 0.375; 95% CI 0.216–0.650) were associated with RS among stroke patients.

Conclusions

Our results suggest that healthy lifestyle (high fruit intake, smoking cessation, housework, and good sleep quality), higher HDL levels, and lack of IHD may be associated with a lower risk of RS in patients with first-onset IS.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez 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 (2016) Executive summary: heart disease and stroke statistics—2016 update: a report from the american heart association. Circulation 133:447–454CrossRefPubMed

Ovbiagele B, Goldstein LB, Higashida RT, Howard VJ, Johnston SC, Khavjou OA, Lackland DT, Lichtman JH, Mohl S, Sacco RL, Saver JL, Trogdon JG (2013) Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke 44:2361–2375CrossRefPubMed

Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C (2004) Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke 35:731–735CrossRefPubMed

Zhu B, Liu H, Pan Y, Jing J, Li H, Zhao X, Liu L, Wang D, Johnston SC, Wang Z, Wang Y, Wang Y (2018) Elevated neutrophil and presence of intracranial artery stenosis increase the risk of recurrent stroke. Stroke 49:2294–2300CrossRefPubMed

Aron AW, Staff I, Fortunato G, McCullough LD (2015) Prestroke living situation and depression contribute to initial stroke severity and stroke recovery. J Stroke Cerebrovasc Dis 24:492–499CrossRefPubMed

Wangqin R, Wang X, Wang Y, Xian Y, Zhao X, Liu L, Li H, Meng X, Wang Y (2017) Risk factors associated with 90-day recurrent stroke in patients on dual antiplatelet therapy for minor stroke or high-risk TIA: a subgroup analysis of the CHANCE trial. Stroke Vasc Neurol 2:176–183CrossRefPubMedPubMedCentral

Wei W, Li S, San F, Zhang S, Shen Q, Guo J, Zhang L (2018) Retrospective analysis of prognosis and risk factors of patients with stroke by TOAST. Medicine 97:e0412CrossRefPubMedPubMedCentral

Raghuram K, Durgam A, Kohlnhofer J, Singh A (2018) Relationship between stroke recurrence, infarct pattern, and vascular distribution in patients with symptomatic intracranial stenosis. J Neurointerv Surg 10:1161–1163CrossRefPubMed

Bai B, Yan Z, Hao Y, Zhang Z, Li G, Dekker J, Qiu C (2017) A randomised controlled multimodal intervention trial in patients with ischaemic stroke in Shandong, China: design and rationale. Lancet 390:S13–S13CrossRef

10.

Tu WJ, Zeng XW, Deng A, Zhao SJ, Luo DZ, Ma GZ, Wang H, Liu Q (2017) Circulating FABP4 (fatty acid–binding protein 4) is a novel prognostic biomarker in patients with acute ischemic stroke. Stroke 48:1531CrossRefPubMed

11.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jimenez 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 (2016) Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation 133:e38–e360

12.

Adams JHP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh REE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41CrossRef

13.

Huang Z, Zhang X, Zhang H, Ye R, Xiong Y (2015) Reduced endothelial progenitor cells in extracranial arterial stenosis but not intracranial arterial stenosis. J Vasc Surg 62:1539–1545CrossRefPubMed

14.

Lee E, Choi K, Ryu J, Jeon S, Lee S, Park S, Park S, Lee J, Choo S, Chung C, Jung S, Kang D, Kim JS, Kwon SU (2011) Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis. J Am Coll Cardiol 57:1811–1818CrossRefPubMed

15.

Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang CH, Stampfer M (2004) Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA 291:565–575CrossRefPubMed

16.

Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ (2018) Promoting physical activity and exercise: JACC health promotion series. J Am Coll Cardiol 72:1622–1639CrossRefPubMed

17.

Noma, KKihara, Y, Higashi Y (2017) Outstanding effect of physical exercise on endothelial function even in children and adolescents. Circ J 81:637–639CrossRef

18.

Tsoupras, ALordan, R, Zabetakis I (2018) Inflammation, not cholesterol, is a cause of chronic disease. Nutrients 10:604CrossRef

19.

Molnar MZ, Lu JL, Kalantar-Zadeh K, Kovesdy CP (2016) Association of incident restless legs syndrome with outcomes in a large cohort of US veterans. J Sleep Res 25:47–56CrossRefPubMedPubMedCentral

20.

Clasadonte J, Scemes E, Wang Z, Boison D, Haydon PG (2017) Connexin 43-mediated astroglial metabolic networks contribute to the regulation of the sleep-wake cycle. Neuron 95:1365–1380.e5CrossRefPubMedPubMedCentral

21.

Itani O, Jike M, Watanabe N, Kaneita Y (2017) Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 32:246–256CrossRefPubMed

22.

Sterr A, Kuhn M, Nissen C, Ettine D, Funk S, Feige B, Umarova R, Urbach H, Weiller C, Riemann D (2018) Post-stroke insomnia in community-dwelling patients with chronic motor stroke: physiological evidence and implications for stroke care. Sci Rep 8:8409CrossRefPubMedPubMedCentral

23.

Kim KT, Moon H, Yang J, Sohn S, Hong J, Cho YW (2017) The prevalence and clinical significance of sleep disorders in acute ischemic stroke patients—a questionnaire study. Sleep Breath 21:759–765CrossRefPubMed

24.

Carlisi CO, Hilbert K, Guyer AE, Ernst M (2017) Sleep-amount differentially affects fear-processing neural circuitry in pediatric anxiety: a preliminary fMRI investigation. Cognit Affect Behav Neurosci 17:1098–1113CrossRef

25.

Huang WS, Muo CH, Chang SN, Chang YJ, Tsai CH, Kao CH (2014) Benzodiazepine use and risk of stroke: a retrospective population-based cohort study. Psychiat Clin Neuros 68:255–262CrossRef

26.

Owolabi M, Sarfo F, Howard VJ, Irvin MR, Gebregziabher M, Akinyemi R, Bennett A, Armstrong K, Tiwari HK, Akpalu A, Wahab KW, Owolabi L, Fawale B, Komolafe M, Obiako R, Adebayo P, Manly JM, Ogbole G, Melikam E, Laryea R, Saulson R, Jenkins C, Arnett DK, Lackland DT, Ovbiagele B, Howard G (2017) Stroke in indigenous Africans, African Americans, and European Americans. Stroke 48:1169–1175CrossRefPubMedPubMedCentral

27.

Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, Creager MA, Culebras A, Eckel RH, Hart RG, Hinchey JA, Howard VJ, Jauch EC, Levine SR, Meschia JF, Moore WS, Nixon JV, Pearson TA (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:517–584CrossRefPubMed

28.

Lin MP, Ovbiagele B, Markovic D, Towfighi A (2016) Association of secondhand smoke with stroke outcomes. Stroke 47:2828–2835CrossRefPubMed

29.

Teuschl Y, Matz K, Firlinger B, Dachenhausen A, Tuomilehto J, Brainin M, Group AS (2017) Preventive effects of multiple domain interventions on lifestyle and risk factor changes in stroke survivors: evidence from a two-year randomized trial. Int J Stroke 12:976–984CrossRefPubMed

30.

Du H, Li L, Bennett D, Guo Y, Key TJ, Bian Z, Sherliker P, Gao H, Chen Y, Yang L, Chen J, Wang S, Du R, Su H, Collins R, Peto R, Chen Z (2016) Fresh fruit consumption and major cardiovascular disease in China. New Engl J Med 374:1332–1343CrossRefPubMed

31.

Hu D, Huang J, Wang Y, Zhang D, Qu Y (2014) Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke 45:1613–1619CrossRefPubMed

32.

Grassi D, Desideri G, Di Giosia P, De Feo M, Fellini E, Cheli P, Ferri L, Ferri C (2013) Tea, flavonoids, and cardiovascular health: endothelial protection. Am J Clin Nutr 98:1660S–1666SCrossRefPubMed

33.

Suen J, Thomas J, Kranz A, Vun S, Miller M (2016) Effect of flavonoids on oxidative stress and inflammation in adults at risk of cardiovascular disease: a systematic review. Healthcare 4:69CrossRefPubMedCentral

34.

Liu RH (2003) Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr 78:517S–520SCrossRef

35.

Amarenco P, Lavallee PC, Labreuche J, Ducrocq G, Juliard JM, Feldman L, Cabrejo L, Meseguer E, Guidoux C, Adrai V, Ratani S, Kusmierek J, Lapergue B, Klein IF, Gongora-Rivera F, Jaramillo A, Abboud H, Olivot JM, Mazighi M, Touboul PJ, Steg PG (2013) Coronary artery disease and risk of major vascular events after cerebral infarction. Stroke 44:1505–1511CrossRefPubMed

36.

Expert Panel On Detection, E. A. T. O., Expert Panel On Detection, E. A. T. O. (2001) executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285:2486–2497CrossRef

37.

Bowman L, Hopewell JC, Chen F, Wallendszus K, Stevens W, Collins R, Wiviott SD, Cannon CP, Braunwald E, Sammons E, Landray MJ (2017) Effects of anacetrapib in patients with atherosclerotic vascular disease. New Engl J Med 377:1217–1227CrossRefPubMed

38.

Fang X, Liu H, Zhang X, Zhang H, Qin X, Ji X (2016) Metabolic syndrome, its components, and diabetes on 5-year risk of recurrent stroke among mild-to-moderate ischemic stroke survivors: a multiclinic registry study. J Stroke Cerebrovasc Dis 25:626–634CrossRefPubMed

39.

Feingold KR, Grunfeld C (2016) Effect of inflammation on HDL structure and function. Curr Opin Lipidol 27:521–530CrossRefPubMed

40.

Ruiz M, Frej C, Holmer A, Guo LJ, Tran S, Dahlback B (2017) High-density lipoprotein-associated apolipoprotein m limits endothelial inflammation by delivering sphingosine-1-phosphate to the sphingosine-1-phosphate receptor 1. Arterioscler Thromb Vasc Biol 37:118–129CrossRefPubMed

41.

Jr FEH (2015) Regression modelling strategies: with applications to Linear Models, Logistic and Ordinal regression, and Survival Analysis. Springer, New York

42.

Pan Y, Song T, Chen R, Li H, Zhao X, Liu L, Wang C, Wang Y, Wang Y (2016) Socioeconomic deprivation and mortality in people after ischemic stroke: the China National Stroke Registry. Int J Stroke 11:557–564CrossRefPubMed

Title: Lifestyles correlate with stroke recurrence in Chinese inpatients with first-ever acute ischemic stroke
Authors: Zhi-Xin Huang
Xiao-Ling Lin
Hai-Ke Lu
Xiao-Yu Liang
Li-Juan Fan
Xin-Tong Liu
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Journal of Neurology / Issue 5/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09249-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lifestyles correlate with stroke recurrence in Chinese inpatients with first-ever acute ischemic stroke

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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