Zhaoping Su

Association of Oxidized Low-Density Lipoprotein With Prognosis of Stroke and Stroke Subtypes.

Background and Purpose— The association between oxidized low-density lipoprotein (oxLDL) and the long-term prognosis of stroke is unclear. The aim of this study is to investigate whether oxLDL levels contribute to the prognosis of stroke and stroke subtypes. Methods— All patients with ischemic stroke were recruited from the SOS-Stroke (Study of Oxidative Stress in Patients With Acute Ischemic Stroke) and classified into 5 different subtypes, according to the TOAST criteria (Trial of Org 10172 in Acute Stroke Treatment). We measured oxLDL levels and followed up with patients at 1 year after stroke onset. We analyzed the association between oxLDL and the clinical outcomes of death and poor functional outcome (modified Rankin Scale score of 3–6) of stroke and different stroke subtypes. Results— Among the 3688 patients included in this study, 293 (7.94%) were deceased at the 1-year follow-up and 1020 (27.66%) had a poor functional outcome. Patients in the highest oxLDL quartile had a higher risk of 1-year stroke mortality (hazard ratio, 1.61; 95% confidence interval, 1.10–2.33; P<0.001) and a poor functional outcome (odds ratio, 1.48; 95% confidence interval, 1.15–1.89; P<0.001) compared with the lowest oxLDL quartile. In the subgroup analyses, oxLDL was only significantly associated with death and poor functional outcome in the large-artery atherosclerosis subgroup (P<0.05) and small-artery occlusion subgroup (P<0.05). Conclusions— High levels of oxLDL were associated with the high risk of death and poor functional outcome within 1 year after stroke onset, especially in large-artery atherosclerosis and small-artery occlusion stroke subtypes.

Brachial-ankle pulse wave velocity and metabolic syndrome in general population: the APAC study

BackgroundMetabolic syndrome (MetS) is correlated with arterial stiffness and can be evaluated by brachial-ankle pulse wave velocity (baPWV). We investigated potential associations between MetS and baPWV in a Chinese community population.MethodsThe community-based Asymptomatic Polyvascular Abnormalities in Community study examined asymptomatic polyvascular abnormalities in a Chinese population aged ≥40 years. The relationship between MetS and its components and baPWV was analyzed by multivariate logistic and linear regression models.ResultsOut of 5181 study participants, 1271 subjects (24.53%) had MetS. Mean values of baPWV in subjects with 0, 1, 2,3, 4, and 5 components of MetS were 1430, 1526, 1647, 1676,1740, and 1860 cm/s, respectively (p < 0.001 for trend). After adjusting for confounding risk factors, MetS was significantly associated with baPWV (odds ratio [OR]: 2.74; 95% CI: 2.28, 3.30). Among the five components of MetS, elevated blood pressure was the most important factor for baPWV. All models of multivariate linear regression analysis showed a significant positive correlation between the increasing numbers of MetS components and baPWV (p < 0.0001).ConclusionsbaPWV was associated with MetS and was greater with increasing numbers of MetS components. Elevated blood pressure was the most important factor for baPWV.

Association between oxidized low-density lipoprotein and cognitive impairment in ischemic stroke patients

The association between oxidized low‐density lipoprotein (oxLDL) and cognitive impairment is unclear. This study aimed to investigate the potential association between oxLDL and cognitive impairment among patients with acute ischemic stroke.

Association of Cumulative Exposure to Resting Heart Rate with Risk of Stroke in General Population: The Kailuan Cohort Study

BACKGROUND AND PURPOSE It remains unclear whether resting heart rate (RHR), particularly cumulative exposure to resting heart rate (cumRHR), is associated with stroke. The aim of our study was to prospectively explore the relationship between cumRHR and stroke morbidity. MATERIALS AND METHODS The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated using a Cox competing risk model. RESULTS A total of 46,568 participants were included in the final analysis. In the observation population, we identified 851 stroke events and 1012 incident death cases in the 4.98 ± .51 year followed-up. Each 46.74 (beats/min) × year increase in heart rate was associated with a 12% increase in the risk of stroke (HR = 1.12, 95% CI = 1.05-1.20). In the categorical model, the highest quartile had an increased risk of stroke (HR = 1.43, 95% CI = 1.13-1.81), compared with the bottom quartile. Gender and age had no interaction with cumRHR for the risk of stroke. CONCLUSION Increase of exposure to cumulative heart rate is independently associated with a higher risk of stroke in the general population.

No Association Between High-Sensitivity C-Reactive Protein and Carotid Intima-Media Progression: The APAC Study

BACKGROUND AND PURPOSE High-sensitivity C-reactive protein (hs-CRP) is a risk indicator for atherosclerosis. However, the association between hs-CRP and early carotid atherosclerosis progression is not well established. We undertook a prospective, community-based, observational study to address this question. METHODS Common carotid artery intima-media thickness (IMT) and hs-CRP values were measured at baseline and after 2 years of follow-up in subjects ≥40 years of age who were participating in the Asymptomatic Polyvascular Abnormalities Community study. Association between hs-CRP values and IMT progression was determined before and after controlling for vascular risk factors. RESULTS IMT was measured in a total of 1918 subjects at baseline and 52.97% of those (1016 of 1918) had IMT progression after 2 years. No significant association between progression of IMT over a 2-year period and average hs-CRP levels was found (multivariate-adjusted, P for trend = .280). Both hs-CRP values measured at baseline (P = .836) and after 2 years of follow-up (P = .440) were not associated with IMT progression levels. Average hs-CRP values were not related to IMT progression levels in a dose-response manner (P = .784). In a subgroup analysis stratified by age and sex, hs-CRP values were also not significantly associated with IMT progression levels (P > .05). CONCLUSION Our results suggest that hs-CRP is not a predictor for the progression of early atherosclerotic changes of the carotid arteries. The hs-CRP levels in early atherosclerosis might be considered as risk markers rather than having a causal role.

Two‐Year Changes in Proteinuria and the Risk of Stroke in the Chinese Population: A Prospective Cohort Study

Background Whether changes in proteinuria are associated with incident stroke in the general population is unclear. This study aimed to investigate the association between changes in proteinuria and incident stroke and its subtypes. Methods and Results The current study included 60 940 Chinese participants (mean age, 50.69 years) who were free of stroke at the time of surveys (2006–2007 and 2008–2009). Participants were divided into 4 categories according to 2‐year changes in proteinuria: no proteinuria, remittent proteinuria, incident proteinuria, and persistent proteinuria. Cox proportional hazards models were used to calculate hazard ratios and their 95% CIs for stroke. After a median follow‐up period of 6.92 years, 1769 individuals developed stroke. After adjustment for confounding factors, incident proteinuria and persistent proteinuria were associated with increased risk of stroke (hazard ratio, 1.46 [95% CI, 1.26–1.68] and hazard ratio, 1.71 [95% CI, 1.42–2.06], respectively) compared with no proteinuria, which were higher than proteinuria detected at one single point (hazard ratio, 1.25; 95% CI, 1.09–1.43). The effect size for risk of stroke subtypes including ischemic stroke and hemorrhagic stroke was similar. Conclusions Changes in proteinuria exposure, particularly persistent proteinuria, are more likely to reflect the risk of stroke, compared with proteinuria collected at a single time point in the general population.

Visit‐to‐Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All‐Cause Mortality in the General Population

Background The association of short‐term variability of fasting plasma glucose (FPG) and mortality has been well investigated. However, the relationships between visit‐to‐visit variability of FPG over longer periods of follow‐up and cardiovascular disease (CVD) and all‐cause mortality are unclear. This study aimed to investigate these relationships. Methods and Results The current analysis included 53 607 Chinese participants (mean age, 49.10 years) who were free of CVD in the Kailuan study. Participants were divided into 4 categories by quartiles of visit‐to‐visit variability of FPG. Visit‐to‐visit variability of FPG was defined as the coefficient of variation of 3 values of FPG that were measured from the examination periods of 2006 to 2007, 2008 to 2009, and 2010 to 2011. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals for CVD and all‐cause mortality. After a mean follow‐up of 4.93 years, 4261 individuals developed CVD and 1545 individuals died. The incidence of CVD and all‐cause mortality was 5.04 and 5.85 per 1000 person‐years, respectively. After adjusting for mean FPG and other potential confounders, individuals in the highest quartile of variability of FPG compared with participants in the lowest quartile showed a 26% greater risk of developing CVD (hazard ratio, 1.26; 95% confidence interval, 1.08–1.47) and a 46% greater risk for all‐cause mortality (hazard ratio, 1.46; 95% confidence interval, 1.25–1.70). Conclusions Independent of mean FPG and other baseline parameters, elevated visit‐to‐visit variability of FPG significantly increases the risk of CVD and all‐cause mortality in the general population. Measuring long‐term visit‐to‐visit variability of FPG is helpful for predicting the risk for CVD and all‐cause mortality.

Proteinuria and risk of stroke in patients with hypertension: The Kailuan cohort study

Proteinuria is associated with stroke, but the effects of changes in proteinuria on stroke risk are not well understood in the hypertensive population. This study examined whether proteinuria changes across 2‐year assessments were associated with incident stroke in individuals with hypertension. We used visit data from 24 300 participants with hypertension of the Kailuan study who were stroke free at baseline. Based on the baseline and 2‐year dipstick screening results, participants were classified as having no, remittent, incident, or persistent proteinuria. The relationship between proteinuria and stroke was analyzed using Cox proportional‐hazards models after adjusting for potential variables. During a median of 6.89‐year follow‐up, we identified 1197 people with stroke. Compared to those with no proteinuria, stroke risk was significantly increased in participants with incident (hazard ratio [HR] 1.41, 95% CI, 1.05‐1.77) and persistent proteinuria (HR 1.49, 95% CI, 1.25‐1.89) after adjustment for other factors, which was consistent in ischemic stroke and intracerebral hemorrhage. No interaction was found between changes of proteinuria and diabetes mellitus in the hypertensive population. Changes in proteinuria exposure, particularly persistent proteinuria, play a role in reflecting the risk of stroke in patients with hypertension.

The relationship between oxidized low-density lipoprotein and the NIHSS score among patients with acute ischemic stroke: The SOS-Stroke Study

BACKGROUND AND AIMS Oxidized low-density lipoprotein (oxLDL) has a defined role in the genesis and development of atherosclerosis, however, whether it is related to severity of neurological deficits is rarely reported. The aim of our study was to investigate the potential association between oxLDL and the National Institutes of Health Stroke Scale (NIHSS) score among patients with acute ischemic stroke. METHODS Between January 2014 and October 2014, we recruited 4111 patients with acute ischemic stroke (AIS), who were admitted within 7 days-43 hospitals in China, and participated in the SOS-Stroke Study. We collected detailed clinical data and then tested the relationship between oxLDL and the NIHSS score using a multivariate linear regression analysis. RESULTS After adjusting for age, gender, ethnicity, marriage and other confounding variables, the elevated NIHSS score was significantly associated with increased oxLDL levels, and each 1-μg/dL elevation in oxLDL concentration resulted in an increase of 0.027 in the NIHSS score. CONCLUSIONS A positive correlation was found between plasma levels of oxLDL and the NIHSS score in patients with acute ischemic stroke. Higher plasma levels of oxLDL potentially suggest a worse prognosis in AIS patients.

Association of Persistent, Incident, and Remittent Proteinuria With Stroke Risk in Patients With Diabetes Mellitus or Prediabetes Mellitus

Background Proteinuria often changes dynamically, showing either regression or progression. The impact of changes in proteinuria on future stroke risk remains largely unknown. We hypothesized that changes in proteinuria would be associated with stroke risk in patients with diabetes mellitus and prediabetes mellitus. Methods and Results The study population included 17 380 participants with diabetes mellitus or prediabetes mellitus enrolled in a prospective Chinese cohort. From the baseline and 2‐year dipstick screening results, participants were classified as having no proteinuria or remittent, incident, or persistent proteinuria. Reduction in proteinuria was calculated as the baseline minus 2‐year proteinuria. Stroke outcomes were assessed in subsequent follow‐ups. Data were analyzed using Cox proportional‐hazards models. During a median follow‐up of 6.9 years, we identified 751 patients with stroke. Stroke risk was increased for participants with persistent (hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.18–2.30), incident (HR, 1.52; 95% CI, 1.22–1.89), and remittent (HR, 1.42; 95% CI, 1.01–2.02) proteinuria compared with those with no proteinuria. Persistent proteinuria was associated with a higher risk of stroke for participants with prediabetes mellitus (HR, 2.58; 95% CI, 1.58–4.22) compared with those with diabetes mellitus (HR, 1.35; 95% CI, 0.86–2.12 [P for interaction=0.0083]). Proteinuria reduction contributed to a decrease in stroke incidence (HR, 0.88; 95% CI, 0.81–0.95). The results were confirmed by sensitivity analyses. Conclusions Persistent, incident, and remittent proteinuria are independent indicators of stroke risk in both diabetic and prediabetic populations.