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Association between cumulative exposure to different lipid parameters and risk of newly developed carotid plaque

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Stroke & Vascular Neurology 2021年第3期6卷 359-365页

作者： Jianwei Wu Yu Wang Kaijiang Kang Anxin Wang Jie Xu xingquan zhao Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Department of Epidemiology and Health Statistics School of Public HealthCapital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of Clinical Epidemiology BeijingChina

Background and purpose Both the magnitude and cumulative exposure of atherogenic lipoproteins have an impact on the atherosclerosis risk,and the exploration focus has shifted from one single lipoprotein assessment to the cumulative exposure of *** aim to investigate the relationship between cumulative exposure to different lipid parameters and the risk of newly developed carotid plaque in this *** In the Asymptomatic Polyvascular Abnormalities Community study,2947 participants were included with follow-up every 2 years from 2006 to *** parameters including total cholesterol(TC),triglycerides(TGs),low-density lipoprotein cholesterol(LDLC),high-density lipoprotein cholesterol(HDLC)and non-HDLC were *** exposure was calculated by adding the weighted sum of the difference between the measured value and the cut-off value of each *** developed carotid plaques were identified by carotid ultrasound performed at the third and fourth *** In the univariate analysis,non-HDLC burden had the highest ORs among the five lipid parameters for newly developed carotid plaque in each quartile,as 1.0(reference),1.35(1.09-1.67),1.68(1.36-2.08)and 2.74(2.22-3.38)from the lowest to the highest *** the multivariate analysis and sensitivity analysis,we obtained similar *** TC burden,TG burden,LDLC burden and non-HDLC burden are all independent risk factors for newly developed carotid plaque,especially for the vulnerable *** lipid parameters,non-HDLC burden is an optimal ***,the predictive value remained significant for participants under the age of 65 years old or free of hypertension,diabetes mellitus and hyperlipidaemia.

关键词： carotid Lipid cholesterol

Body mass index and clinical outcomes in patients with intracerebral haemorrhage:results from the China Stroke Center Alliance

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Stroke & Vascular Neurology 2021年第3期6卷 424-432,I0054-I0057页

作者： Zhentang Cao Xinmin Liu Zixiao Li Hongqiu Gu Yingyu Jiang xingquan zhao Yongjun Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Disease BeijingChina

Background and aim Obesity paradox has aroused increasing concern in recent ***,impact of obesity on outcomes in intracerebral haemorrhage(ICH)remains *** study aimed to evaluate association of body mass index(BMI)with in-hospital mortality,complications and discharge disposition in *** Data were from 85705 ICH enrolled in the China Stroke Center Alliance *** were divided into four groups:underweight,normal weight,overweight and obese according to Asian-Pacific *** primary outcome was in-hospital *** secondary outcomes included non-routine discharge disposition and in-hospital *** to graded II or III hospital,community hospital or rehabilitation facilities was considered non-routine *** logistic regression analysed association of BMI with *** 82789 patients with ICH were included in the final ***(OR=2.057,95%CI 1.193 to 3.550)patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates,but no significant difference was observed for patients who were overweight or *** significant association was found between BMI and *** was associated with increased odds of several complications,including pneumonia(OR 1.343,95%CI 1.138 to 1.584),poor swallow function(OR 1.351,95%CI 1.122 to 1.628)and urinary tract infection(OR 1.532,95%CI 1.064 to 2.204).Moreover,obese patients had higher odds of haematoma expansion(OR 1.326,95%CI 1.168 to 1.504),deep vein thrombosis(OR 1.506,95%CI 1.165 to 1.947)and gastrointestinal bleeding(OR 1.257,95%CI 1.027 to 1.539).Conclusions In patients with ICH,being underweight was associated with increased in-hospital *** underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

关键词： patients routine mortality

Night-time diastolic blood pressure variability relates to stroke recurrence in patients who had ischaemic stroke with small artery occlusion

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Stroke & Vascular Neurology 2022年第3期7卷 237-244页

作者： Tingting Wang Jie Xu Anxin Wang Ying Liu xingquan zhao Yongjun Wang Yilong Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina

Background and purpose The association between blood pressure variability(BPV)and stroke recurrence among patients who had ischaemic stroke(IS)remains *** study aimed to investigate the association between BPV and stroke recurrence in patients who had IS of large artery atherosclerosis(LAA)subtype and small artery occlusion(SAO)*** Data from the BOSS(Blood Pressure and Clinical Outcome in Transient Ischemic Attack or Ischemic Stroke)study were *** subtypes were diagnosed according to the Trial of Org 10172 in Acute Stroke Treatment *** was performed by 24-hour ambulatory blood pressure monitoring and defined through SD of blood *** primary outcome was stroke recurrence within 90 days after *** Cox regression model was used to assess the association between BPV and stroke recurrence in patients who had IS of LAA subtype and SAO *** A total of 1390 patients who had IS from the BOSS study were included in the present *** analysis suggests that 24-hour systolic BPV(SBPV)and night-time diastolic BPV(DBPV)were significantly associated with stroke recurrence among all patients who had IS(HR,2.50,95%CI 1.07 to 5.84;HR,1.85,95%CI 1.07 to 3.21,respectively).Night-time SBPV and night-time DBPV were significantly associated with stroke recurrence in patients with SAO subtype(HR,2.77,95%CI 1.07 to 7.15;HR,3.60,95%CI 1.39 to 9.29,respectively).However,in the adjusted model,only night-time DBPV remained significant in patients with SAO subtype(HR,3.87,95%CI 1.40 to 10.71).Similar results were not found in patients who had IS of LAA *** High night-time DBPV was associated with increased risk of stroke recurrence among patients who had IS of SAO *** results of this study have implications for the secondary prevention management and future research of patients who had IS of SAO *** association between BPV and stroke recurrence in patients who had IS of LAA su

关键词： patients diastolic Blood

In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes

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Stroke & Vascular Neurology 2024年第1期9卷 8-17,I0001-I0033页

作者： Yu Tian Mengxing Wang Yuesong Pan Xia Meng xingquan zhao Liping Liu Yongjun Wang Yilong Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina

Introduction It remains unclear whether enlarged perivascular spaces(EPVS)predict poor clinical outcomes in patients with acute ischaemic stroke(AIS)or transient ischaemic attack(TIA).Method Data were obtained from the Third China National Stroke Registry *** estimated EPVS in basal ganglia(BG)and centrum semiovale(CSO)using a semiquantified scale(Grade from 0 to 4).Using Cox and logistic regression analyses,the associations of EPVS with 3-month and 1-year adverse outcomes(including recurrent stroke,ischaemic stroke,haemorrhagic stroke,combined vascular event,disability and mortality)were *** analyses of any association of cerebral small vessel disease at baseline and development of a small arterial occlusion(SAO)were *** Among 12603 patients with AIS/TIA,median age was 61.7±11.6 years,and 68.2%were *** adjusting for all potential confounders,frequent-to-severe BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke(HR 0.71,95%CI 0.55 to 0.92,p=0.01)but an increased risk of haemorrhagic stroke(HR 1.99,95%CI 1.11 to 3.58,p=0.02)at 1 year after AIS/TIA,compared with none-to-mild *** with frequent-to-severe CSO-EPVS had a decreased risk of disability(OR 0.76,95%CI 0.62 to 0.92,p=0.004)and all-cause death(HR 0.55,95%CI 0.31 to 0.98,p=0.04)within 3-month but not 1-year follow-ups,compared with those with none-to-mild *** analyses showed that both BG-EPVS(HR 0.43,95%CI 0.21 to 0.87,p=0.02)and CSO-EPVS(HR 0.58,95%CI 0.35 to 0.95,p=0.03)were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year *** BG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 ***,caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.

关键词： patients haemorrhagic prevention

Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack:a systematic review and meta-analysis

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Stroke & Vascular Neurology 2018年第2期3卷 107-116页

作者： Yingying Yang Mengyuan Zhou Xi Zhong Yongjun Wang xingquan zhao Liping Liu Yilong Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina

Objective Recent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke *** updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke(IS)or transient ischaemic attack(TIA).Methods We searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May *** ratio(RR)with 95%CI were calculated using random effects *** endpoints included stroke recurrence,composite vascular events and major *** 18 randomised controlled trials including 15515 patients were pooled in the *** compared with monotherapy among patients with acute IS or TIA,dual antiplatelet therapy reduced the risk of stroke recurrence(RR 0.69;95%CI 0.61 to 0.78;p<0.001)and composite vascular events(RR 0.72;95%CI 0.64 to 0.80;p<0.001).Dual therapy was associated with a significant increase in the risk of major bleeding(RR 1.77;95%CI 1.09 to 2.87;p=0.02)when all trial data were ***,when all previous trials before the completion of the POINT trial were analysed,dual antiplatelet versus monotherapy was not associated with a significant increase in the risk of major bleeding(RR 1.46;95%CI 0.77 to 2.75;p=0.25).Conclusions Among patients with acute noncardioembolic IS or TIA within 3 days of ictus,dual antiplatelet therapy was associated with a reduction in stroke recurrence,and composite vascular events,when compared with ***,a significant increase in the risk of major bleeding was observed.

关键词： acute embolic bleeding

In- hospital complications affect short- term and long- term mortality in ICH: a prospective cohort study

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Stroke & Vascular Neurology 2021年第2期6卷 201-206页

作者： Yaqing Zhang Yongjun Wang Ruijun Ji Anxin Wang Yilong Wang Zhonghua Yang Liping Liu Penglian Wang xingquan zhao Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina

Background Medical complications strongly affected the mortality of patients with ***,only limited research has studied the effect of in-hospital medical complications on the mortality of patients with spontaneous intracerebral haemorrhage(ICH)*** the China National Stroke Registry,the effect was prospectively and systematically investigated in patients with spontaneous ICH during their hospitalisation,at 3,6 and 12 months after disease *** This study collected data on patients over 18 years old with spontaneous ICH from 132 Chinese clinical centres across 32 provinces and four municipalities(Hong Kong included),from September 2007 to August *** on patient complications,death and other information were acquired through paper-based registry *** multivariable logistic regression,the association of medical complications with stroke outcomes was *** Of 3255 patients with spontaneous ICH,878(26.97%)had in-hospital medical ***-hospital medical complications were independent risk factors for death during the hospitalisation(adjusted OR 4.41,95% CI 3.18 to 6.12),at 3 months(adjusted OR 2.18,95% CI 1.70 to 2.80),6 months(adjusted OR 1.84,95% CI 1.45 to 2.34)and 12 months(adjusted OR 1.59,95% CI 1.26 to 2.01)after spontaneous *** The results revealed that the short-term and long-term mortality of patients with spontaneous ICH in China was significantly associated with their in-hospital medical complications.

关键词： complications prospective mortality

Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY): protocol for a multicentre, randomised controlled trial

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Stroke & Vascular Neurology 2024年第1期9卷 75-81,I0047-I0052页

作者： Xiaoling Liao Shuo Feng Yicong Wang Yuesong Pan Weiqi Chen Hui Qu xingquan zhao Liping Liu Yongjun Wang Yilong Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing TiantanHospitalCapital Medical UniversityBeijingChina Chinese Institute for Brain Research BeijingChina National Center for Neurological Diseases BeijingChina Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina Beijing Laboratory of Oral Health Capital Medical UniversityBeijingChina

Background Perforating artery territorial infarction(PAI)caused by branch atheromatous disease(BAD)is prone to recurrence and early progression without an effective and well-documented antiplatelet treatment ***,an adjunctive antiplatelet agent,has shown great potential to treat acute ischaemic ***,whether the combination of tirofiban and aspirin can improve the prognosis of PAI remains *** To explore an effective and safe antiplatelet regimen for reducing the risk of recurrence and early neurological deterioration(END)in PAI caused by BAD by comparing the tirofiban and aspirin combination with placebo and aspirin *** Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction(STRATEGY)trial is an ongoing multicentre,randomised,placebo-controlled trial in *** patients shall be randomly assigned to receive standard aspirin with tirofiban or placebo on the first day and standard aspirin from days 2 to *** primary endpoint is a new stroke or END within 90 *** primary safety endpoint is severe or moderate bleeding within 90 *** The STRATEGY trial will assess whether tirofiban combined with aspirin is effective and safe in preventing recurrence and END in patients with *** registration number NCT05310968.

关键词： Aspirin regimen centre

Risk factors associated with 90-day recurrent stroke in patients on dual antiplatelet therapy for minor stroke or high-risk TIA:a subgroup analysis of the CHANCE trial

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Stroke & Vascular Neurology 2017年第4期2卷 176-183页

作者： Runqi Wangqin Xianwei Wang Yilong Wang Ying Xian xingquan zhao Liping Liu Hao Li Xia Meng Yongjun Wang Duke Clinical Research Institute Duke University Medical CenterDurhamNorth CarolinaUSA Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurology Duke University Medical CenterDurhamNorth CarolinaUSA

Objective Many patients receiving dual antiplatelet therapy still had recurrent *** aimed to identify factors associated with recurrent stroke at 90 days in patients receiving dual antiplatelet therapy in Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events *** Patients with transient ischaemic attack or minor stroke receiving clopidogrel and aspirin in the trial were analysed in the *** primary outcome was recurrent stroke within 90 days after the index *** proportional hazard model with backward selection was used to identify factors associated with *** Among 2584 patients,212(8.2%)had a recurrent stroke,216(8.4%)had a composite of stroke,myocardial infarction,or vascular death and 204(7.9%)had ischaemic stroke within 90 *** analysis identified the following factors associated with stroke:history of hypertension with poor blood pressure control(HR,1.92;95%CI 1.22 to 3.03),the high baseline National Institute of Health Stroke Scale(NIHSS)score of 2 and 3(2.12(1.07 to 4.21)and 4.11(2.05 to 8.22),respectively),time from onset to randomisation of<12 hours(1.47(1.12 to 1.94)),the lipid-lowering therapy(0.61(0.47 to 0.83)),the open-label aspirin dose at day 1 of≥300 mg(1.98(1.45 to 2.69)).Intracranial arterial stenosis(ICAS)was significantly associated with stroke in the sensitivity analysis(2.17(1.16 to 4.04)).conclusions The high baseline NIHSS score,hypertension with poor blood pressure control,ICAS,time from onset to randomisation of less than 12 hours and no lipid-lowering therapy were associated with stroke,suggesting that patients with identified predictors still remain to be at high risk of recurrent stroke although being under the dual antiplatelet therapy.

关键词： patients Acute analysis

Comparison of outcome of patients with acute minor ischaemic stroke treated with intravenous t-PA, DAPT or aspirin

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Stroke & Vascular Neurology 2021年第2期6卷 187-193页

作者： Peng Wang Mengyuan Zhou Yuesong Pan Xia Meng xingquan zhao Liping Liu Hao Li Yongjun Wang Zhimin Wang Yilong Wang Neurology Department Zhejiang Provincial People's HospitalHangzhouChina Neurology Department Beijing Tiantan HospitalBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina Neurology Department The First people's Hospital of TaizhouTaizhouChina

Background Whether to treat minor stroke with intravenous tissue plasminogen activator(t-PA)treatment or antiplatelet therapy is a *** study aimed to explore whether intravenous t-PA treatment,dual antiplatelet therapy(DAPT)and aspirin have different efficacies on outcomes in patients with minor *** A post hoc analysis of patients with acute minor stroke treated with intravenous t-PA within 4.5 hours from a nationwide multicentric electronic medical record and patients with acute minor stroke treated with DAPT and aspirin from the Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack *** stroke was defined by a score of 0-3 on the National Institutes of Health Stroke Scale at *** functional outcome(defined as modified Rankin Scale(mRS)score of 0-1 or 0-2 at 3 months).Results Compared with those treated with intravenous t-PA,no significant association with 3-month favourable functional outcome(defined as mRS score of 0-1)was found neither in patients treated with aspirin(87.8%vs 89.4%;OR,0.83;95% CI,0.46 to 1.50;p=0.53)nor those treated with DAPT(87.4%vs 89.4%;OR,0.84;95% CI,0.46 to 1.52;p=0.56).Similar results were observed for the favourable functional outcome defined as mRS score of 0-2 at 3 *** In our study,no significant advantage of intravenous t-PA over DAPT or aspirin was *** to insufficient sample size,our study is probably unable to draw such a conclusion that that intravenous t-PA was superior or non-superior to DAPT.

关键词： DAPT aspirin intravenous