Huang Zhi-Xin, Yuan Shumin, Li Dongshi, Hao Hong, Liu Zhenguo, Lin Jianguo
Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.
Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA.
Risk Manag Healthc Policy. 2021 Feb 2;14:365-377. doi: 10.2147/RMHP.S289761. eCollection 2021.
Stroke is the leading cause of morbidity and mortality in China. Recurrent stroke (RS) could occur in a significant portion of patients with ischemic stroke with devastating consequence.
To investigate the association between lifestyle and the risk of RS in Chinese patients with acute large-vessel ischemic stroke (ALVIS). A total of 258 patients with ALVIS were recruited in the study (median age 63 years, 30.6% female), and followed for a median of 366 days. The primary outcomes were first RS. Cox Regression and Akaike information criterion were used to establish the best-fit nomograms.
During follow-up, 38 of 258 (14.7%) participants had the primary endpoint event. After adjusting for confounding factors in multivariate Cox regression analysis, healthy lifestyles, including bland diet (hazard ratio [HR], 0.365; 95% CI, 0.138-0.965), daily fruit consumption (HR, 0.474; 95% CI, 0.238-0.945), good sleep (HR, 0.364; 95% CI, 0.180-0.739), housework: HR (0.461; 95% CI, 0.200-1.065), and HDL (HR, 0.329; 95% CI, 0.130-0.831) were associated with significantly decreased risk for RS after ALVIS, while smoking was associated with a substantial increase in RS risk (HR, 2.590; 95% CI, 1.340-5.005) and included into the nomogram. A weighted point (from 0 to 100) was given to each risk factor, and the total points could be used to predict the probability of RS for the patient.
The nomogram shows that healthy lifestyles (bland diet, daily fruit consumption, good sleep, cigarette cessation, and housework) were important for reducing RS in patients with ALVIS.
中风是中国发病和死亡的主要原因。复发性中风（RS）在很大一部分缺血性中风患者中可能发生，后果严重。
为了研究中国急性大血管缺血性中风（ALVIS）患者的生活方式与RS风险之间的关联。本研究共招募了258例ALVIS患者（中位年龄63岁，女性占30.6%），并进行了中位366天的随访。主要结局为首次RS。采用Cox回归和赤池信息准则建立最佳拟合列线图。
随访期间，258例参与者中有38例（14.7%）发生主要终点事件。在多变量Cox回归分析中调整混杂因素后，健康的生活方式，包括清淡饮食（风险比[HR]，0.365；95%可信区间，0.138 - 0.965）、每日食用水果（HR，0.474；95%可信区间，0.238 - 0.945）、良好睡眠（HR，0.364；95%可信区间，0.180 - 0.739）、家务劳动：HR（0.461；95%可信区间，0.200 - 1.065）和高密度脂蛋白（HR，0.329；95%可信区间，0.130 - 0.831）与ALVIS后RS风险显著降低相关，而吸烟与RS风险大幅增加相关（HR，2.590；95%可信区间，1.340 - 5.005）并纳入列线图。给每个风险因素赋予一个加权分数（从0到100），总分可用于预测患者发生RS的概率。
列线图显示，健康的生活方式（清淡饮食、每日食用水果、良好睡眠、戒烟和家务劳动）对降低ALVIS患者的RS很重要。
