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中国营养学会第十五届全国营养科学大会

作者： Guowei Li Gregory Lip Guangdong Second Provincial General Hospital University of Liverpool

Evidence for the association between vitamin D and risk of recurrent stroke remains sparse and limited. We aimed to assess the relationship between serum circulating 25-hydroxyvitamin D(25(OH)D) level and risk of recurrent stroke in patients with a stroke history, and to identify the optimal 25(OH)D level in relation to lowest recurrent stroke risk. Methods Data from the nationwide prospective United Kingdom Biobank were used for analyses. Primary outcome was time to first stroke recurrence requiring a hospital visit during follow-up. We used Cox proportional hazards regression model with restricted cubic splines to explore 25(OH)D level in relation to recurrent stroke. The dose-response relationship between 25(OH)D and recurrent stroke risk was also estimated, taking the level of 10 nmol/L as reference. Results A total of 6,824 participants(mean age: 60.6 years, 40.8% females) with a baseline stroke were included for analyses. There were 388(5.7%) recurrent stroke events documented during a mean follow-up of 7.6 years. Using Cox proportional hazards regression model with restricted cubic splines, a quasi J-shaped relationship between 25(OH)D and risk of recurrent stroke was found, where the lowest recurrent stroke risk lay at the 25(OH)D level of approximate 60 nmol/L. When compared with 10 nmol/L, a 25(OH)D level of 60 nmol/L was related with a 48% reduction in the recurrent stroke risk(hazard ratio = 0.52, 95% confidence interval: 0.33-0.83). Conclusion Based on data from a large-scale prospective cohort, we found a quasi Jshaped relationship between 25(OH)D and risk of recurrent stroke with the lowest risk at around 60 nmol/L. These results may provide some insights into the optimal vitamin D status recommendation for recurrent stroke prevention in patients with a prior stroke history.

关键词： vitamin D recurrent stroke 25-hydroxyvitamin stroke prevention

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Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke

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World Journal of Clinical Cases 2023年第32期11卷 7814-7821页

作者： Jian-Quan Zhang Zhi-Bin Pan Department of Emergency Medicine The First Affiliated Hospital of Jiangxi Medical CollegeShangrao 334000Jiangxi ProvinceChina Department of Neurology Jiujiang First People's HospitalJiujiang 332100Jiangxi ProvinceChina

BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

关键词： Aspirin Acute stroke Antiplatelet therapy recurrent stroke recurrent vascular events Myocardial infarction

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Blood Pressure Lowering for the Secondary Prevention of stroke

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Cardiology Discovery 2022年第1期2卷 51-57页

作者： Shunsuke Funakoshi Miki Kawazoe Kazuhiro Tada Makiko Abe Hisatomi Arima Department of Preventive Medicine and Public Health Faculty of MedicineFukuoka UniversityFukuoka 814-0180Japan Department of Neurology Faculty of MedicineFukuoka UniversityFukuoka 814-0180Japan Division of Nephrology and Rheumatology Department of Internal MedicineFaculty of MedicineFukuoka UniversityFukuoka 814-0180Japan.

Hypertension is one of the most important modifiable risk factors for stroke,and greater than 50%of all stroke events are estimated to be attributable to elevated blood pressure(BP).Randomized trials and meta-analyses have demonstrated that reducing BP is the most effective and generalizable strategy for preventing recurrent stroke.Based on currently available evidence,BP should be reduced to below 140/90 mmHg in all patients during the chronic post-stroke phase and to below 130/80 mmHg when welltolerated.

关键词： Hypertension recurrent stroke Antihypertensive medications

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Long-term prognosis and prognostic determinants of patients with first attack of mild and moderate ischemia at Beijing community hospitals

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Neural Regeneration Research 2012年第7期7卷 540-545页

作者： Xianghua Fang Liming Li Xinqing Zhang Hongjun Liu Hongmei Zhang Xiaoming Qin Department of Epidemiology ＆ Biostatistics School of Public Health Peking University Health Sciences Center Beijing 100191 China Department of Evidence-based Medicine Xuanwu Hospital Capital Medical University Beijing 100053 China Department of Neurology Xuanwu Hospital Capital Medical University Beijing 100053 China Department of Geriatrics Xuanwu Hospital Capital Medical University Beijing 100053 China

A total of 710 patients with first-ever ischemic stroke were consecutively recruited between January 2003 and December 2004 from five community hospitals/stations in five districts of Beijing, China. As of December 31, 2008, a total of 2 477 person-years were followed-up. During the five-year follow-ups, 117 adverse events occurred, including all-cause death and acute cardiovascular events （recurrent stroke, acute myocardial infarction, and sudden death）. The five-year cumulative mortality rate was 2.18/100 person-years （54 cases）, with 3.88/100 person-years （96 cases） of acute cardiovascular events and 3.02/100 person-years （75 cases） of recurrent stroke. Multiple factor analyses using the Cox proportional hazards ratio models showed that age, diabetes, and dependence of activities of daily living were independent predictors for death, acute cardiovascular disease events, or recurrent stroke. The results demonstrated that recurrent stroke was a major vascular disease that affected the prognosis of mild or moderate stroke patients. Secondary prevention of stroke patients should include active management of vascular risk factors and rehabilitation.

关键词： ischemic stroke follow-up study predictors prognosis recurrent stroke survival

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