| BackgroundStroke was the leading cause of death in china. The incidence of stroke was still increasing while the case fatality was going down. Patients who have lived through stroke attack will be more volunerable to death or recurrence. According to the primary and secondary prevention guidline of stroke, through treatment of major risk factors can effectively reduce the occurrence and recurrence of stroke. The staus of pre-hospital risk factors are a true reflect of the status of risk factors when stroke was occurring. In terms of the data about stroke recurrence rate, we need more recent year’s natonwide recurrence rate derived from long term follow up data.Part Ⅰ The prevalence of risk factors and status of pre-hospital treatment among hospitalized patients with stroke in ChinaObjectivesThe purpose of the study was to analyze pre-hospital risk factors status and treatment rate of risk factors before onset of stroke. The study will provide the evidence to improve the primary and secondary prevention of stroke.MethodThis study is a multi-center cross-sectional study; we continuously collected information of hospitalized patients with acute stroke from 41 hospitals located in 25 provinces of China during January to May in 2011. The prevalence of hypertension, diabetes, elevated-LDL-C, drinking, smoking, atrial fibrillation and family history of stroke in both first-ever and recurrence stroke were counted. Then according to Framingham stroke risk profile and patients’pre-hospital risk factor status, we classify the first-ever stroke patients to different risk stratification.ResultsTotally 20570 patients meet the inclusion criteria were analyzed in this study. The average age of all recruited stroke patients was 63.0±12.9 year old,13062 of them were male,15329 were first-ever stroke patients, and 17052 were ischemic stroke.53.1% patients were lower than 65 years old. (1)There were 75.5% of patients with hypertension,53.5% with elevated LDL-C,37.3% with diabetes, and 6.5% with atrial fibrillation (AF).75.2% patients had two or more risk factors and 43.0% patients had three or more risk factors. (2) Among first-ever stroke patients,53.3% was classified as high risk and 25.9% was classified as low risk group; But 42.1% of the first-ever stroke patients lower than 65 years old came from the low stroke risk according their pre-hospital risk factor status and current definition of risk classification. (3) Among the first-ever stroke patients, the awareness rate of hypertension was 70.3% but only 8.0% of those patient reached the target of BP control. The awareness rate of diabetes was 70.3%, but the treatment rates and control rates were lower than 50%; The awareness rate, treatment rate and control rate of elevated LDL-C were the lowest compared with other risk factors-lower than 10%. The same circumustons were observed in the recurrent stroke patients.ConclusionsMost stroke patients had multiple risk factors of stroke in pre-hospitalization. The primary prevention and secondary prevention of stroke need to be improved in China. More than 55% percent first-ever stroke were lower than 65 years old. We need to enhance the prevention of risk factors in people under 65. The result of risk assement shows that the 10-year stroke risk assement was not fit the people under 65.Part Ⅱ 4-year commulative recurrence rate after first-ever stroke and it’s risk factorsObjectivesThe purpose of the study was to provide the recurrence rate after first-ever stroke in our country and to evaluate the pridictors for the stroke recurrence.MethodThis study was a prospective corhot study, patiensts derived from 30 tertiary hospitals were followed up during August 2014 and March 2015 through telephone or face to face. Using the multivariable Cox regression model to estimate the risk factors affect stroke recurrence.Results8796 patients were enrolled in on baseline. Finally 7211 patients finish the follow up were analyzed (4420 were female,65.8±12.5 years old). On the baseline 757 patients were hemorrhagic stroke,6016 were ischemic stoke,434 both have hemorrhagic stroke and ischemic stoke.1. Occurrence of end point events during the follow up periodThe study comprised 14883 person-years of follow-up. The mean follow-up time was 2.0 years (median,2.0 years). There were 749 patients recurrent overall, and the one-year recurrence rate was 5.62%,2-year cumulative recurrence rate was 8.49%,3-year cumulative recurrence rate was 9.86%,4-year cumulative recurrence rate was 10.39%. Among the 749 recurrence patients 338 were died from the recurrence events. Totally 484 oatients were died after first-ever stroke, case fatality were 6.7%, 383 were died from CVD.2. Recurrence of different characteristics patients2.1 Recurrence rate among different characteristics patientsThe recurrence rate in male and female were similar,4-year comulative recurrence rate was 10.63% in male and 10.00% in female. Patients older than 65 years old have a higher recurrence rate than other age group. Comparison of recurrence rate between different regions shows that Central region has the lowest recurrence rate,4-year comulative recurrence rate was 6.86%, and recurrence rate in western region was highest.4-year comulative recurrence rate was 17.50%, about three times in the east. Patients with diabetes have higher recurrence rate,4-year comulative recurrence rate was 12.30%. Patients with AF also have higher recurrence rate,4-year comulative recurrence rate was 21.47%. Whether patients with smoking, drinking, whether to hace a family history of stroke, the recurrence rate of stroke were same. When take multiple risk factors together, patients with three or more risk factors have a higher recurrence rate,4-year cumulative recurrence rate was 11.59%.2.2 Motality of recurrence event in different characteristics patientsRecurrence case fatality rate was slightly higher than male, but did not reach statistical difference. More than half of patients older than 65 years old died when they recur stroke. Comparison between different regions shows that, deaths of recurrent stroke have significant differences across the regions. About 40.81% patients died from recurrence stroke in eastern region,29.6% in central region,60.0% in western region, and more than half of the patients died out of hospital.3. Pridictors for recurrence after first-ever strokeOlder than 65 years old, AF were the main risk factors for recurrence, and taking anticoagulation and antiplatelet drugs can reduce the recurrence of patients. After adusted age and gender, patients with three or more risk factors have a higher recurrence rate than other patients. The kinds of risk factors influcing recurrence were similar in different baseline stroke type patients.Conclusions4-year comulative recurrence rate of first-ever stroke patients in our country was 10.39% and was different among sex and age group and different region. The recurrence rise along with the age increasing. The western region has the highest cumulative recurrence stroke, it is about three times that of the central region. Older than 65 years old, AF and with three or more risk factors were the main risk factors for recurrence, and taking anticoagulation and antiplatelet drugs can reduce the recurrence of patients. |
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