Other countries have seen a decline in stroke incidence after improved treatment and prevention of known risk factors for stroke. China is still experiencing significant increases in the incidence rate of total stroke. We systematically reviewed the evidence on the impact of 5 modifiable risk factors (hypertension, dyslipidemia, obesity, diabetes, and smoking) for the risk of stroke in the Chinese population, with the aim to develop more effective prevention and disease management programs. A literature search was conducted in MEDLINE and EMBASE for all observational studies that reported on the association between risk of stroke and any of the 5 risk factors and the composite risk factor. Selected articles were published in either English or Chinese from January 2004 to December 2010. Evidence of the association between hypertension and stroke was the strongest of the 5 factors reported in studies, with adjusted odds ratios ranging between 2.75 and 5.47. The association among obesity, diabetes, smoking, and the risk for stroke was evident, but not as strong as for hypertension. The risk ratios of hypertension to stroke were higher in the Chinese population than those in other countries.

A systematic literature review of risk factors for stroke in China.

OBJECTIVE Progressive cerebral infarctions increase mortality and functional disability through mechanisms which have yet to be completely understood. The goal of this study was to explore the dynamic changes of serum C-reactive protein (CRP), fibrinogen (FIB) and D-dimer (D-D) in order to better characterize progressive cerebral infarction. METHODS The amount of serum CRP, FIB and D-D was measured in 82 patients with progressive cerebral infarction by taking samples from the internal carotid artery (progressive group), and in 186 patients with non-progressive cerebral infarction (non-progressive group) by using an automatic biochemical analyzer during the next day (day 1), day 3, day 7, and day 14 after being admitted to hospital. Carotid vascular ultrasound and neurological deficit score (National Institutes of Health Stroke Scale, NIHSS) were also recorded. RESULTS Carotid stenosis ratio was significantly higher in the progressive group than in the non-progressive group (P < 0.01) on admission. In the progressive group, CRP increased significantly on day 3, followed by a decline on day 7 and day 14, but was significantly higher than those in the non-progressive group (P < 0.01). The levels of FIB and D-D increased in the progressive group more than those in the non-progressive group on day 3, day 7, and day 14 (P < 0.01). The progressive group patients' NIHSS score gradually increased after admission, which was opposite to the non-progressive group patients whom followed a downward trend. The difference between these two groups was significant (P < 0.01). CONCLUSION Observing changes of CRP, FIB and D-D may contribute to early identification and timely treatment of progressing ischemic strokes.

Serum C-reactive protein, fibrinogen and D-dimer in patients with progressive cerebral infarction.

Objectives: Several studies have sought factors predictive of early neurological deterioration during acute stroke; however, no study carried out a systematic search for factors capable of predicting early improvement. This investigation is aimed at identifying the variables associated with short-term neurological improvement in patients with ischemic stroke not undergoing thrombolysis. Methods: Two-hundred and fifty-two patients with ischemic stroke were retrospectively examined (mean age: 76·7±10·6 years, 120 males, median delay of admission 8 hours). Stroke severity was assessed both on admission and at discharge (median stay: 4 days) by the National Institutes of Health Stroke Scale (NIHSS). Improvement was defined as a difference between initial and final assessment (ΔNIHSS) ≧the median value (2 points). Thus, 127 patients improved (mean change: +3·8 points) and 125 did not (mean change: −1·4 points). Results: During the first 48 hours of hospitalization, 263 clinical, laboratory, instrumental, and t...

Predictors of short-term improvement of ischemic stroke.

Background Leukotrienes are arachidonic acid derivatives long known for their inflammatory properties. Leukotriene-based inflammation has been demonstrated to play a crucial role in atherosclerosis, a major risk factor for several human diseases. Recently, human genetic studies from us and others suggest that single nucleotide polymorphisms (SNPs) in leukotriene pathway genes influence the risk of atherosclerotic diseases such as stroke. This study aimed to assess the role of additional leukotriene pathway genes as a stroke risk factor within the Chinese Han population. Methods We sequenced the promoter, exonic, and intronic regions of leukotriene A4 hydrolase (LTA4H) and arachidonate 5-lipoxygenase (ALOX5), and then genotyped five SNPs in LTA4H and four SNPs in ALOX5 among 691 cases with stroke and 732 controls from the Chinese population. Results We detected a significant association between an intronic SNP in LTA4H (rs6538697) and stroke in our subjects (adjusted odds ratio, recessive model, 1.75; P = 0.022); and the SNP rs2029253 in ALOX5 was associated with a decreased risk of stroke (adjusted odds ratio, 0.76; 95% confidence interval, 0.59 - 0.97). Conclusion Genetic variants in LTA4H and ALOX5 may modulate the risk of stroke in the Chinese Han population.

Association between genetic variants of the leukotriene biosynthesis pathway and the risk of stroke: a case-control study in the Chinese Han population.

Ischemic stroke is a clinical sign of brain dysfunction or tissue damage caused by lack of blood flow to the brain that disrupts the blood and oxygen requirements in the brain tissue. In Indonesia, stroke is the third ranks after heart disease and malignancy. The prompt diagnosis can reduce morbidity and mortality. CT-scan is the gold standard, but it has some limitations that are difficult to recognize the early signs of ischemia on the first day and the cost of the related treatment is expensive. Because of these limitations, such case require another sign that is noninvasive, sensitive, specific, easier and cheaper to detect the presence of thrombus while the cause of ischemic stroke is D-dimer. This study was design to know the diagnostic value of plasma levels of D-dimer of the CT-scan in acute ischemic stroke by determination. A cross-sectional study was conducted, where forty patients with inclusion criteria were taken from The Neurology Department. The research was done at the Department of Clinical Pathology RSUP.H.Adam Malik/FK USU Medan. CT-scan as the gold standard for the D-dimer examination Plasma levels of D-dimer using latex agglutination method with a cut-off 500/mL. Statistical analysis using a 2×2 table to determine the sensitivity, specificity, positive predictive value, negative predictive value, prevalence and the likelihood ratio. The result found were as follows: sensitivity 77.7%, specificity 53.8%, positive predictive value 77.7%, negative predictive value 53.8%, prevalence 67.5%, likelihood ratio positive 1.74 and the likelihood ratio negative 0.43. Based on this study, the level plasma D-dimer could possibly can be used as an exclusion diagnostic in acute ischemic stroke case.

/pdf/kadar-d-dimer-plasma-di-strok-iskemik-akut-25am8200ju.pdf

Kadar d-dimer plasma di strok iskemik akut

Background The mortality and disability associated with progressing ischemic stroke are much higher than general ischemic stroke. This study was conducted to determine the risk factors for progressing ischemic stroke in the Han population of northeast China. Methods A total of 2511 patients with ischemic stroke within 24 hours admitted to Department of Neurology, First Affiliated Hospital of Harbin Medical University were studied, from November 2007 to May 2009. All of the patients were classified into the progressing or non-progressing group according to the scores of the Scandinavian Neurological Stroke Scale. Fifteen putative risk factors were evaluated. The influence of risk factors for progressing ischemic stroke was analyzed with the simple Logistic analysis, the multiple Logistic analysis, and the stepwise Logistic regression model. All the statistical analysis was performed by SAS 9.1. Results Totally 359 (14.3%) patients met the criteria for progressing ischemic stroke. The Logistic analysis showed that age, family stroke history, smoking history, hypertension on admission, a drop in blood pressure after admission to the hospital, high serum glucose on admission, and fever were related to progressing ischemic stroke in the Han population of northeast China. Conclusion People of the ischemic stroke with these factors are more likely to develop progressing ischemic stroke.

Association between fifteen risk factors and progressing ischemic stroke in the Han population of northeast China.

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Association between fifteen risk factors and progressing ischemic stroke in the Han population of northeast China.