The Study Of The Correlation Between The Risk Factors Of Ischemic Stroke Including Lipoprotein(a) And TCM Constitution

ObjectiveScreen high-risk population of ischemic stroke and assess their TCM constitutions.To observe the distribution of TCM constitutions in high risk population of ischemic stroke.To analyze the correlation between risk factors of ischemic stroke including lipoprotein(a)and TCM constitutions.Detect the lipoprotein(a)plasma concentration of the objects and assess their carotid by ultrasonography.And analyze the correlation between TCM constitutions and lipoprotein(a)in high risk population of ischemic stroke.MethodsThe cross-sectional investigation was developed to screen the patients'risk factors of ischemic stroke and identify the feature of their constitutions.The patients were all from cerebrovascular disease clinic,heart disease clinic and diabetes clinic of Guangdong Provincial Hospital,as well as the general internal medicine clinic and physical examination center respectively.At the same time,the investigations were carried on in the other six hospitals.The six hospitals are in Foshan,Qingyuan,Taishan and Meizhou.Screening cycle was from January 1,2017 to December 31,2017 and a total of1516 subjects were included in the study.All the subjects should sign the informed consent.Then the researchers conducted the demographic information,medical history and other data collection.Subsequent screening of lipoprotein(a)test and carotid color Doppler ultrasound examination were carried on.And the traditional Chinese medicine constitutions of the subjects were assessmented as well.The information and the test results were filled in the data acquisition tables.The data entry was completed by researchers,responding the information collected in the data collection tables.A specially-assigned person was responsible for the data verification and custody.When the study was accomplished,the data was statistically analyzed.Results1.The frequencis of risk factors in high-risk population of ischemic stroke varied greatly.The frequecncy of the risk factors from high to low was high blood pressure(1170/77.2%),lack of exercise(693/45.7%),dyslipidemia(538/35.5%),overweight or obesity(465/30.7%),diabetes(247/16.3%),smoking(282/18.6%),acohol abusing(112/7.4%),family history of stroke or cardiovascular disease(65/4.3%),atrial fibrillation and valvular heart disease(31/2.0%),transient ischemic attack(26/1.7%)and sleep apnea(18/1.2%).The results revealed that the most common high risk factor of the subjets in this study was hypertension,and next were exercise deficit,dyslipidemia,overweight or obesity.Sleep apnea was the least.2.TCM constitutions distribution of population at high risk of ischemic stroke(1)General distributionOf all high-risk population of ischemic stroke,58.4%was single constitution and 41.6%was compound constitutions.The frequencies of the TCM constitutions from high to low were mild constitutional quality(530/35.0%),phlegm-dampness quality(366/24.1%),qi deficiency constitution(325/21.4%),blood stasis(297/19.6%),yang deficiency(259/17.1%),yin deficiency(218/14.4%),qi stagnation(182/12.0%),damp-heat constitution(134,8.8%),special appetency constitution(63/4.2%).(2)Gender differenceThere is gender difference about the distribution of TCM constitutions of high-risk ischemic stroke population.The most common TCM constitution for both men and women were mild constitutional quality.There was significant difference in the distribution of the three types of constitutions between male and female.The three types were damp-heat constitution(13.3%VS 4.9%),qi stagnation(9.9%vs 13.8%)constitution and special appetency constitution(3.0%VS 5.2%).Significant difference was observed in the distribution of hot and humid constitution(P<0.001).(3)Age differenceThe TCM constitutions distribution of people at high risk of stroke has age differences.There were significant differences in the distribution of yang deficiency constitution,qi deficiency constitution,damp-heat constitution,blood stasis constitution,qi stagnation constitution and mild constitution among the three age groups(P<0.05).Among them,yang deficiency,qi deficiency,blood stasis constitutional quality were the most distributed in the eldest group,and were the least in the postadolescent group.The damp-heat constitution,qi stagnation constitution and mild constitution were the most distributed in the postadolescent group,and were the least in the eldest group.3.Correlation of TCM constitutions and risk factors in high-risk population of ischemic stroke(1)HypertensionYang deficiency constitution(r_s=-0.072,P=0.005),qi deficiency constitution(r_s=-0.185,P<0.001)and qi stagnation constitution(r_s=-0.056,P=0.030)were negatively correlated with hypertension;yin deficiency constitution(r_s=0.088,P=0.001)and phlegm-damp constitution(r_s=0.075,P=0.003)constitution were positively correlated with hypertension.Other types of TCM constitutions were not related to hypertension.(2)DiabetesYang deficiency constitution(r_s=-0.056,P=0.031)and mild constitution(r_s=-0.161,P<0.001)were negatively correlated with diabetes;Yin deficiency constitution(r_s=0.088,P=0.001),phlegm-dampness constitution(r_s=0.134,P<0.001)were positively correlated with diabetes.Other types of TCM constitutions were not related to diabetes.(3)DyslipidemiaPhlegm-dampness constitution(r_s=0.133,P<0.001)was positively correlated with dyslipidemia;mild constitution(r_s=-0.197,P<0.001)was significantly negatively correlated with dyslipidemia.Other types of TCM constitutions were not related to dyslipidemia.(4)SmokingThere was a positive correlation between damp-heat constitution(r_s=-0.093,P=0.021)and smoking.At the same time,mild constitution(r_s=-0.059,P<0.001)was positively correlated with smoking.Other types of TCM constitutions were not related to smoking.(5)Excessive drinkingThere was a positive correlation between damp-heat constitution and excessive alcohol consumption(r_s=0.338,P<0.001);mild constitution(r_s=-0.123,P<0.001)and blood stasis constitution(r_s=-0.082,P=0.001)were negatively correlated with excessive alcohol consumption.Other types of TCM constitution were not related to excessive drinking.(6)Overweight or obesityThere was a positive correlation between overweight/obesity and phlegm-dampnessconstitution(r_s=-0.038,P<0.001).Yangdeficiency constitution(r_s=-0.069,P=0.009),yin deficiency constitution(r_s=-0.060,P=0.022),qi deficiency constitution(r_s=-0.089,P=0.001),blood stasis constitution(r_s=-0.071,P=0.007),and mild constitution(r_s=-0.205,P<0.001)all had a negative correlation with overweight or obesity.4.Correlation of TCM constitutions and lipoprotein(a)in population with high risk of ischemic strokeThere was a positive correlation between the special appetency constitution and the high level of lipoprotein(a).There was a negative correlation between yang deficiency constitution,qi deficiency constitution,qi depression constitution and high level of lipoprotein(a).The rest of the TCM constitution types were not correlated with the increase of lipoprotein(a)plasma concentration.5.Correlation of TCM constitutions and lipoprotein(a)with carotid atherosclerosis in high risk population of ischemic stroke(1)The carotid atherosclerosis of high risk population of ischemic strokeOf the 1516 subjects enrolled,496 patients completed carotid ultrasound examination,of which 381 were diagnosed with carotid atherosclerosis,accounting for 76.8%of the total number of patients and the detection rate of carotid atherosclerotic plaques was 64.3%.(2)The correlation of TCM constitutiond and carotid artery IMT thickening in high risk population of ischemic strokeThere was a positive correlation of Yang deficiency constitution(r_s=0.147,P=0.001),Qi deficiency constitution(r_s=0.100,P=0.026)and blood stasis constitution(r_s=0.148,P=0.001)with carotid artery IMT thickening.There was a negative correlation between mild(r_s=-0.131,P=0.003)and carotid artery thickening.Other types of TCM constitutions were not related to the thickening of the carotid artery IMT.(3)The correlation of TCM constitutions and carotid atherosclerotic plagues in high risk population of ischemic strokeThere was a negative correlation between mild constitution(r_s=-0.127 P=0.005)and the formation of carotid atherosclerotic plaques.Other types of TCM constitutions were not related to the formation of carotid atherosclerotic plaques.(4)The correlation of lipprotein(a)and carotid atherosclerosis in high risk population of ischemic strokeUnivariate analysis showed that in both high lipoprotein(a)group(?300mg/dL)and low lipoprotein(a)group(<300mg/L),the proportion of the patients who had carotid artery IMT thickening and carotid atherosclerotic plaques had no difference(P>0.05).The risk factors related to atherosclerosis,such as lipoprotein(a),sex,age and so on,were taken as independent variables,and carotid artey IMT as well as carotid atherosclerotic plagues were analyzed by multiple factors and unconditional stepwise regression analysis.The results showed that all the lipoprotein(a)did not enter the regression equation.The risk factors selected which was associated with the carotid artery IMT were gender,age,hypertension,high TC(?6.22mmol/L)and risk factors associated with carotid atherosclerotic plagues were gender,age,hypertension,diabetes,drinking and high LDL(?4.14mmol/L).Conclusion1.Hypertension is the commonest risk factor in high risk population of ischemic stroke.At the same time,there is a large proportion of lifestyle risk factors such as physical activity deficiency,overweight or obesity,and smoking.2.In general,mild constitution is the commnset TCM constitution of high risk population of ischemic stroke.In the biased constitution,Qi deficiency constitution and blood stasis constitution are more common.The distribution of TCM constitutions in the high risk population of ischemic stroke has gender difference and age difference.3.The risk factors of ischemic stroke and lipoprotein(a)are related to the TCM constitutions.4.The TCM constitutions of the high risk population of ischemic stroke are related to carotid atherosclerosis.5.The increase of lipoprotein(a)is not related to the thickening of the carotid artery IMT and the formation of atherosclerotic plaques.