Jianwei Wu

Ideal Cardiovascular Health Metrics and the Risks of Ischemic and Intracerebral Hemorrhagic Stroke

Background and Purpose— Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively. Methods— We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91  698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006–2007). Cox proportional hazards models were used to estimate stroke risk. Results— During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69–1.23), 0.69 (0.52–0.92), 0.52 (0.39–0.68), 0.38 (0.28–0.51), 0.27 (0.18–0.40), and 0.24 (0.11–0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01). Conclusions— We observed a clear inverse gradient relationship between the number of ideal CVH metrics and the risk of stroke in a Chinese population, supporting the importance of ideal health behaviors and factors in stroke prevention.

Measures of Adiposity and Risk of Stroke in China: A Result from the Kailuan Study

Objective The objective of this study was to explore the association between adiposity and risk of incident stroke among men and women. Methods We studied the relationship between adiposity and stroke among 94,744 participants (18–98 years old) in the Kailuan study. During a follow-up of 4 years, 1,547 ischemic or hemorrhagic strokes were recorded. Measurements of adiposity included body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated from Cox regression models and each model fit was assessed using −2log-likelihood. Results Every measurement of adiposity was associated with the risk for total stroke and ischemic stroke, but not for hemorrhagic stroke. After adjusting for confounders and intermediates, the HR (comparing the mean of the highest quintile with that of the lowest quintile) for total stroke was 1.34(1.13–1.60) for BMI, 1.26(1.06–1.52) for WC, 1.29(1.08–1.56) for WHpR, and 1.38(1.15–1.66) for WHtR. The HR for ischemic stroke was 1.52(1.24–1.88) for BMI, 1.46(1.17–1.81) for WC, 1.40(1.12–1.74) for WHpR, and 1.62(1.29–2.04) for WHtR. The model fit for each of the indices was similar. Conclusions Adiposity increases the total risk of stroke and ischemic stroke, but not of hemorrhagic stroke. No clinically meaningful differences among the associations between BMI, WC, WHpR, and WHtR and stroke incidence were identified in this study.

Ideal Cardiovascular Health Metrics on the Prevalence of Asymptomatic Intracranial Artery Stenosis: A Cross-Sectional Study

Background and Purpose Intracranial Artery Stenosis (ICAS) is one of the most common causes of ischemic stroke in Asia. Previous studies have shown the number of ideal cardiovascular health (CVH) metrics was associated with lower risk of stroke. This study aimed to investigate the relationship between ideal CVH metrics and prevalence of ICAS. Methods A random sample of 5,412 participants (selected from Kailuan Study as a reference population) aged 40 years or older (40.10% women), free of stroke, transient ischemic attack, and coronary disease, were enrolled in the Asymptomatic Polyvascular Abnormalities Community study from 2010 to 2011. We collected information on the seven CVH metrics (including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol and fasting blood glucose); and assessed ICAS by transcranial Doppler. The relationship between the ideal CVH metrics and prevalence of ICAS was analyzed using the multivariate logistic regression. Results After adjusting for age, sex, and other potential confounders, the adjusted odds ratios(95% confidence interval) for ICAS were 0.76(0.58–0.99), 0.55(0.43–0.72), 0.49(0.37–0.65), 0.43(0.31–0.61), and 0.36(0.22–0.62), respectively, for those having 2, 3, 4, 5, and 6–7 ideal CVH metrics compared with those having 0–1 ideal metric(p-trend<0.0001). Similar inverse associations were observed in different age and gender groups (all p-trends<0.05). Conclusion We found a clear gradient relationship between the number of ideal CVH metrics and lower prevalence of ICAS in a Chinese population, which supports the importance of ideal health behaviors and factors in the prevention of ICAS.

Relationship between C - Reactive Protein and Stroke: A Large Prospective Community Based Study

Objective Previous studies have suggested that C-reactive protein (CRP) was associated with risk of stroke. There were few studies in Asian population, or on stroke subtypes other than ischemic stroke. We thus investigated the relationship between CRP and the risks of all stroke and its subtypes in a Chinese adult population. Methods In the current study, we included 90,517 Chinese adults free of stroke and myocardial infarction at baseline (June 2006 to October 2007) in analyses. Strokes were classified as ischemic stroke (IS), intracranial heamorrhage (ICH) and subarachnoid heamorrhage (SAH). High-sensitivity CRP (hs-CRP) were categorized into three groups: <1 mg/L, 1 to 3 mg/L, and >3 mg/L. Cox proportional hazards regression was used to calculate the association between hs-CRP concentrations and all stroke, as well as its subtypes. Results During a median follow-up time of 49 months, we documented 1,472 incident stroke cases. Of which 1,049 (71.3%) were IS, 383 (26.0%) were ICH, and 40 (2.7%) were SAH. After multivariate adjustment, hs-CRP concentrations ≥1 mg/L were associated with increased risks of all stroke (hs-CRP 1–3 mg/L: hazard ratio (HR) 1.17, 95% confidential interval (CI) 1.03–1.33; hs-CRP>3 mg/L: HR 1.25, 95% CI 1.07–1.46) and IS (hs-CRP 1–3 mg/L: HR 1.17, 95% CI 1.01–1.36; hs-CRP>3 mg/L: HR 1.33, 95% CI 1.11–1.60), but not with ICH and SAH. Subgroup analyses showed that higher hs-CRP concentration was more prone to be a risk factor for all stroke and IS in non-fatal stroke, male and hypertensive participants. Conclusion We found that higher hs-CRP concentrations were associated with a higher risk of IS, particularly for non-fatal stroke, male and hypertensive subjects. In contrast, we did not observe significant associations between hs-CRP and ICH/SAH.

Non-High-Density Lipoprotein Cholesterol on the Risks of Stroke: A Result from the Kailuan Study

Aims To prospectively explore the association between non-high-density lipoprotein cholesterol (non-HDLC) and the risks of stroke and its subtypes. Methods A total of 95,916 participants (18-98 years old; 76,354 men and 19,562 women) from a Chinese urban community who were free of myocardial infarction and stroke at baseline time point (2006-2007) were eligible and enrolled in the study. The serum non-HDLC levels of participants were determined by subtracting the high-density lipoprotein cholesterol (HDLC) from total serum cholesterol. The primary outcome was the first occurrence of stroke, which was diagnosed according to the World Health Organization criteria and classified into three subtypes: ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. The Cox proportional hazards models were used to estimate risk of stroke and its subtypes. Results During the four-year follow-up, we identified 1614 stroke events (1,156 ischemic, 416 intracerebral hemorrhagic and 42 subarachnoid hemorrhagic). Statistical analyses showed that hazard ratios (HR) (95% Confidence Interval: CI) of serum Non-HDLC level for total and subtypes of stroke were: 1.08 (1.03-1.12) (total), 1.10 (1.05-1.16) (ischemic), 1.03 (0.96-1.10) (intracerebral hemorrhage) and 0.83 (0.66-1.05) (subarachnoid hemorrhage). HR for non-HDLC refers to the increase per each 20 mg/dl. For total and ischemic stroke, the risks were significantly higher in the fourth and fifth quintiles of non-HDLC concentrations compared to the first quintile after adjusting the confounding factors (total stroke: 4th quintile HR=1.33 (1.12-1.59); 5th quintile HR = 1.36 (1.15-1.62); ischemic stroke: 4th quintile HR =1.34 (1.09-1.66); 5th quintile HR = 1.53 (1.24-1.88)). Conclusions Our data suggest that serum non-HDLC level is an independent risk factor for total and ischemic stroke, and that higher serum non-HDLC concentrations are associated with increased risks for total stroke and ischemic stroke, but not for intracerebral and subarachnoid hemorrhage.

A Comparison of Brain Death Criteria between China and the United States.

Background: Criteria for determining brain death (BD) vary between China and the United States. We reported the results of an investigation designed to compare procedures to determine BD in two countries. Methods: The latest criteria in the United states were published in 2010. The latest criteria in China were published in 2009. We used these two types of BD criteria to evaluate patients who were considered to be BD. The time, cost, and accuracy of the diagnosis were compared. Results: From January 1, 2012 to October 8, 2013, there were 37 patients which were applied for BD evaluation in the Neurological Intensive Care Unit of Beijing Tiantan Hospital. The cause of coma were known as subarachnoid hemorrhage (18 patients, 48.6%), intracerebral hemorrhage (8 patients, 21.6%), cerebral ischemia (9 patients, 24.3%), brain stem tumor (1 patient, 2.7%), and intracranial infection (1 patient, 2.7%). The clinical examinations were done for all of the patients except 1 patient who had low blood pressure. Three patients had brainstem reflexes that were excluded from BD. Twenty-five patients had apnea tests, and 20 tests were completed that were all positive. Confirmatory tests were completed differently: Transcranial Doppler (30 patients, positive rate 86.7%), electroencephalogram (25 patients, positive rate 100%), and somatosensory evoked potential (16 patients, positive rate 100%). Thirty-three patients were diagnosed BD by criteria of the United States. Only 9 patients were diagnosed BD by Chinese criteria. The use of time and money in the USA criteria was obviously fewer than those in Chinese criteria (P = 0.000). Conclusion: Compared with BD criteria of the United States, Chinese criteria were stricter, lower positive rate, more cost in money and time, and more reliable by families and doctors.

Association between Non-High-Density-Lipoprotein-Cholesterol Levels and the Prevalence of Asymptomatic Intracranial Arterial Stenosis

Objective The aim of this study was to assess the association between non-high-density-lipoprotein-cholesterol (non-HDL-C) and the prevalence of asymptomatic intracranial arterial stenosis (ICAS). Methods and Results The Asymptomatic Polyvascular Abnormalities Community (APAC) study is a prospective cohort study based on the Kailuan district (China) population. A total of 5351 eligible subjects, aged ≥40, and without history of stroke or myocardial infarction, were enrolled in this study. Transcranial Doppler Ultrasonography (TCD) was performed on all enrolled subjects for the evaluation of ICAS presence. Out of 5351 patients, 698 subjects showed evidence of ICAS (prevalence of 13.04%). Multivariate analysis showed that non-HDL-C is an independent indicator for the presence of ICAS (OR  = 1.15, 95%CI: 1.08 – 1.23), but with a gender difference (P for interaction<0.01): in men, non-HDL-C is an independent indicator for ICAS (multivariate-adjusted OR  = 1.28, 95%CI: 1.18–1.39), but not in women (multivariate-adjusted OR  = 1.03, 95%CI: 0.93–1.14). Subjects were divided into five subgroups based non-HDL-C levels and these levels correlated linearly with the prevalence of ICAS (P for trend <0.01). Compared with the first quintile, multivariate-adjusted OR (95%CI) of the second, third, fourth and fifth quintiles were: 1.05 (0.71–1.56), 1.33 (0.91–1.95), 1.83 (1.27–2.63), 2.48 (1.72–3.57), respectively. Conclusion Non-HDL-C is an independent predictor of ICAS prevalence in men but not in women, suggesting that non-HDL-C levels could be used as a surveillance factor in the primary prevention of ischemic stroke, especially in men.

Association between high sensitivity C-Reactive protein and prevalence of asymptomatic carotid artery stenosis

INTRODUCTION Inflammation plays a key role in the pathophysiology of atherosclerosis. Little is known about the association between high sensitivity C-reactive protein (hs-CRP) especially long-term hs-CRP and asymptomatic carotid artery stenosis (ACAS) in healthy Chinese adults. The aim of this study was to assess the relationship between hs-CRP levels and the prevalence of ACAS in a Chinese community-based cohort. METHODS A sample of 5349 participants aged ≥ 40 years (40.36% women) were enrolled in this study, all without preexisting stroke. Ultrasonography of the bilateral carotid arteries was performed for the evaluation of carotid stenosis. Participants were stratified into three groups according to hs-CRP levels. We used both baseline (hs-CRP levels analyzed during 2010) and average hs-CRP values for the last four years (the average of hs-CRP levels analyzed at the year of 2006, 2008 and 2010) in the analysis. Multivariable logistic regression models were used to analyze the association between hs-CRP levels and ACAS. RESULTS A total of 356 (6.66%) subjects showed evidence of ACAS. Multivariate analysis showed that both baseline and average hs-CRP values for the last four years were independent indicators for the presence of ACAS (P for trend = 0.007, 0.001, respectively). Stratified by age and sex, higher baseline hs-CRP levels were associated with ACAS in old adults (≥ 60 y) (multivariate-adjusted, odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05) and male (multivariate-adjusted, OR = 1.03, 95%CI: 1.01-1.05), but not in middle-aged adults (40-59 y) and female. Similarly, higher average hs-CRP values for the last four years were associated with ACAS in old adults and male, but not in middle-aged adults and female. CONCLUSION Both baseline and chronic elevation of serum hs-CRP were associated with ACAS, especially in older or male adults. hs-CRP might be used as a useful marker and a potential therapeutic target for carotid atherosclerosis.

Elevated fasting glucose as a potential predictor for asymptomatic cerebral artery stenosis: A cross-sectional study in Chinese adults

BACKGROUND AND PURPOSE Cerebral artery stenosis is known as an important cause of stroke, and elevated fasting glucose level is also considered as a risk factor for stroke. Our aim was to exam whether elevated fasting glucose is associated with cerebral artery stenosis, especially asymptomatic cerebral artery stenosis. METHODS The current study included 5309 participants who were age of 40 years or older, and free of stroke, transient ischemic attack, and coronary artery disease. Cerebral artery stenosis was assessed by Doppler ultrasound. Participants were classified into four subtypes: no cerebral artery stenosis (NCS), intracranial artery stenosis (ICAS), extracranial carotid artery stenosis (ECCS) and combined intracranial artery and extracranial carotid artery stenosis (IECS). Fasting blood glucose concentrations were grouped into: normal fasting glucose (<5.60 mmol/l), impaired fasting glucose 1 (IFG1) (5.60-6.09 mmol/l), IFG2 (6.10-6.99 mmol/l) and diabetes (≥ 7.00 mmol/l). A multinomial logistic regression was used to examine the association between fasting glucose and cerebral artery stenosis, after adjusting for potential confounders. RESULTS Fasting glucose level was significantly higher in ICAS and IECS groups than the other two groups. In the multinomial logistic regression analysis, IFG2 was the risk factor for ICAS (odds ratio (OR) 1.53, 95% confidential interval (CI), 1.12-2.10), and diabetes was a strong predictor for both ICAS (OR 1.75, 95% CI, 1.38-2.22) and IECS (OR 2.14, 95% CI 1.31-3.49). However, fasting glucose level was not significantly associated with ECCS. CONCLUSIONS Our results showed that elevated fasting glucose levels are associated with asymptomatic cerebral artery stenosis, especially ICAS and IECS.

Non-high-density lipoprotein cholesterol vs low-density lipoprotein cholesterol as a risk factor for ischemic stroke: a result from the Kailuan study.

Abstract Objectives: To compare the predictive value of serum low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (non-HDL) cholesterol levels for ischemic stroke in the Chinese population. Methods: We performed a four-year cohort study of 95 778 men and women, aged 18–98 years, selected from the Kailuan study (2006–2007). Baseline LDL cholesterol levels were estimated using direct test method. Total cholesterol levels were estimated using endpoint test method. The predictive values of LDL cholesterol and non-HDL cholesterol for ischemic stroke were compared. Results: During the follow-up period, there were 1153 incident cases of ischemic stroke. The hazard ratio (HR) for ischemic stroke in the top quintile of LDL cholesterol was the highest among five quintiles (HR: 1·25; 95% confidence interval (CI), 1·01–1·53). The HR in the top quintile of non-HDL cholesterol for ischemic stroke was also the highest among five quintiles (HR: 1·53; 95% CI, 1·24–1·88). Analysis of trends showed a significant positive relationship between ischemic stroke incidence and serum LDL cholesterol level, and non-HDL cholesterol level, respectively (both P < 0·05). The area under the curve of LDL cholesterol and non-HDL cholesterol for ischemic stroke was 0·51 and 0·56, respectively (P < 0·05 for the difference). Conclusions: Serum Non-HDL cholesterol level is a stronger predictor for the risk of ischemic stroke than serum LDL cholesterol level in the Chinese population.