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Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular Neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Philip Appleton Lisa J Woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark Dixon Timothy J England Kailash Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey L Saver Angela Shone Aloysius Niroshan Siriwardena Joanna M Wardlaw Nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science Center BeijingChina Neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service NHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurology and Psychology University of GlasgowGlasgowUK Bob Champion Research and Education Building University of East AngliaNorwichUK Institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurology Oslo University HospitalOsloNorway Research and Development Norwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Health Research unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is unclear.Here,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of onset.The primary outcome was a shift in scores on the modified Rankin scale(mRS)at day 90.Secondary outcomes included death;a global analysis(Wei-Lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’markers.Data were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%CI.Results 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]min.Neuroimaging‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe stroke.Conclusions In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital trials.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those with acute stroke treated within 6hours of stroke

关键词： Glasgow nitrate random

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Design of a Biomedical Device to Reduce Anxiety Experienced by Patients Diagnosed with Parkinson’s Disease

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Journal of Biomedical Science and Engineering 2024年第3期17卷 57-71页

作者： Madhini Vigneswaran Anjali Menon Research Department MEDIC Foundation Vancouver Canada

Parkinson’s disease (PD) is a neurodegenerative disease that occurs due to loss of nerve cells that produce dopamine in the brain, affecting approximately 4 million people worldwide. PD patients often feel an increase in anxiety levels daily. While there are medications/exercises to help relieve anxiety, there are limited methods to reduce anxiety without the help of a caretaker. As a result, MEDIC foundation, a non-profit organization in british Columbia, Canada, is designing an automated system that consists of a wristband and an application which uses vi-bration therapy to help reduce anxiety of PD patients. Literature reviews were conducted to document the project’s needs. Phase I of the project focused on de-veloping a prototype for the application and phase II on developing the wrist-band. The team developed prototypes of a wristband that automatically applies vibration near the median nerve as the heart rate variability (HRV) deviates away from the normal threshold of the user, and an application that displays real-time heart rate variability signals as well as provides for relaxation. The development of the prototype is still in early progress. By creating this automated system, we aim to provide a solution to senior PD patients to relieve anxiety independently. .

关键词： Vibration Therapy Healthcare Application Parkinson’s Disease Anxiety Wristband heart Rate Variability

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Renal denervation as an option for the management of hypertension

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The Journal of Biomedical Research 2014年第1期28卷 18-24页

作者： Georgina Radhini Santiapillai Albert Ferro Department of Clinical Pharmacology Cardiovascular DivisionBritish Heart Foundation Centre of Research ExcellenceKing's College London

Hypertension is a multifactorial condition which makes the development of treatment approaches difficult. The vast majority of patients are treated with lifestyle measures either alone or in combination with antihypertensive drugs, and this approach is largely successful in controlling blood pressure. However, for a subgroup of patients, control of blood pressure remains resistant to this approach and therefore the development of new strategies is im- perative. The sympathetic nervous system has been known to be implicated in hypertension for many decades, and evidence from studies in the past has revealed the benefit of reducing sympathetic nerve activity in the control of blood pressure albeit with severe side effects. Recent technological advances have allowed for specific targeting of the renal sympathetic nerves by catheter ablation. The Symplicity HTN-1 and HTN-2 trials have provided strong evidence for renal denervation giving rise to considerable blood pressure reductions in treatment-resistant hyper- tensives and, due to the high incidence of hypertension worldwide, this carries the promise of further reducing the global burden of hypertension and its attendant complications. Here we review the evidence for renal denervation in the management of hypertension.

关键词： hypertension renal denervation blood pressure

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cardiovascular risk burden,dementia risk and brain structural imaging markers:a study from UK Biobank

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General Psychiatry 2024年第1期37卷 94-102页

作者： Yaying Cao Gaohong Zhu Chengwu Feng Jing Chen Wei Gan Yuan Ma Yonghua Hu Klodian Dhana Trudy Voortman Jie Shen Ting Li Yan Zheng Changzheng Yuan Geng Zong Department of Food Nutrition and Health School of Medicine and HealthHarbin Institute of TechnologyHarbinHeilongjiangChina CAS Key Laboratory of Nutrition Metabolism and Food SafetyShanghai Institute of Nutrition and HealthChinese Academy of SciencesShanghaiChina Department of Nuclear Medicine First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanChina Neurology Department Zhongshan Hospital Affliated with Fudan UniversityShanghaiChina Medical Research Council Population Health Research unit University of OxfordOxfordUK Department of Genetics Novo Nordisk Research Centre OxfordOxfordUK Harvard University T H Chan School of Public Health BostonMassachusettsUSA Department of epidemiology and Biostatistics School of Public HealthPeking UniversityBeijingChina Department of Internal Medicine Rush University Medical CenterChicagolinoisUSA Department of epidemiology rasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands Division of Human Nutrition and Health Wageningen University&ResearchWageningenThe Netherlands School of Public Health the Second Afliated HospitalZhejiang University School of MedicineHangzhouZhejiangChina First Afiliated Hospital of Kunming Medical University KunmingYunnanChina State Key Laboratory of Genetic Engineering School f ife SCciencesFudan UniversityShanghaiChina Ministry of Education Key Laboratory of Public Health Safety School of Public HealthFudan UniversityShanghaiChina The Key Laboratory of Inteligent Preventive Medicine of Zhejang Province HangzhouZhejiangChina Shanghai Jiao Tong University Affiliated Sixth People's Hospital ShanghaiChina

Background cardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure,while the role of genetics and incident cardiovascular disease(CVD)remains unclear.Aims To examine the association of overall cardiovascular risk burden with the risk of major dementia subtypes and volumes of related brain regions in a large sample,and to explore the role of genetics and CVD onset.Methods A prospective study among 354 654 participants free of CVD and dementia(2006-2010,mean age 56.4 years)was conducted within the UK Biobank,with brain magnetic resonance imaging(MRl)measurement availablefor 15104participants since 2014.CVD risk burden was evaluated by the Framingham General cardiovascular Risk Score(FGCRS).Dementia diagnosis was ascertained from inpatient and death register data.Results Overamedian 12.0-yearfollow-up,3998 all-cause dementia cases were identified.Higher FGCRS was associated with increasedall-cause dementia risk after adjusting for demographic,major lifestyle,clinical factors and the polygenic risk score(PRS)of Alzheimer's disease.Comparing the high versus low tertile of FGCRS,the odds ratios(ORs)and 95%confidence intervals(Cls)were 1.26(1.12 to 1.41)for all-cause dementia,1.67(1.33 to 2.09)for Alzheimer's disease and 1.53(1.07 to 2.16)for vascular dementia(all p_(treng)heart disease accounted for 14%(95%Cl:9% to 21%)of the association between FGCRS and all-cause dementia.Interactions were not detected for FGCRS and PRS on the risk of any dementia subtype.We observed an 83%(95%Cl:47%to 128%)higher all-cause dementia risk comparing the high-high versus low-low FGCRS-PRS category.For brain volumes,higher FGCRS was associated with greater log-transformed white matter hyperintensities,smaller cortical volume and smaller grey matter volume.Conclusions Our findings suggest that the positive association of cardiovascular risk burden with dementia risk also applies to major dementia subtypes.The association of cardiovascular risk burden wit

关键词： cardiovascular diagnosis burden

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When and how does brain-derived neurotrophic factor activate Nrf2 in astrocytes and neurons？

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Neural Regeneration Research 2018年第5期13卷 803-804页

作者： Tetsuro Ishii Giovanni E.Mann University of Tsukuba Tsukuba Japan School of cardiovascular Medicine and Sciences King's British Heart Foundation Centre of Excellence Faculty of Life Sciences and Medicine King's College Iondon London UK

Circadian rhythm protects neurons：Although the master clock entrains the whole body rhythm,peripheral tissues also express core clock transcription factors Clock and Bmal1,which regulate expression of clock genes including Period（Per）and Cryptochrome（Cry）proteins.Complexes of Per and Cry proteins repress Bmal1-and Clock-mediated transcription forming a negative feedback loop,which regulates nearly a 24 hours self-sustained rhythm including energy metabolism.

关键词： When and how does brain-derived neurotrophic factor activate Nrf2 in astrocytes and neurons NGF

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Inflammatory response to coronary artery bypass surgery: Does the heme-oxygenase-1 gene microsatellite polymorphism play a role?

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Chinese Medical Journal 2005年第15期118卷 1285-1290页

作者： LI Ping Jules Sanders Emma Hawe David Brull Hugh Montgomery Steve Humphries cardiovascular Department Second Affiliated Hospital of Jiangxi Medical College Nanchang 330006 China Centre for cardiovascular Genetics British Heart Foundation Laboratories Department of Medicine Royal Free ＆ University College London Medical School Rayne Building 5 University Street London WC1E 6JF UK

Background Heme-oxygenase 1 （HO-1） is a rate-limiting enzyme in the degradation of heme to bilirubin, ferritin and carbon monoxide （CO） and may have significant anti-inflammatory function. The HO-1 gene promoter region shows microsatellite polymorphism with different （GT）n repeats, reported to differently induce gene expression, with the short allele associated with higher gene expression. We measured the acute inflammatory response using coronary artery bypass surgery （CABG） as a well-characterized and uniform stimulus and examined the correlation between levels of IL-6, C-reactive protein （CRP） and fibrinogen and their relationship to HO-1 genotype. Methods Two hundred and seventy-five consecutive patients undergoing CABG were genotyped for the HO-1 promoter polymorphism using PCR and automated DNA capillary sequencer. IL-6, CRP and fibrinogen were measured at baseline and 6, 24, 48, 72, 96 and 120 hours after CABG. Results Complete IL-6, CRP and fibrinogen measures were available in 220 patients. Before surgery IL-6 levels showed a strong correlation with CRP and fibrinogen （ r = 0. 48, P 〈 0. 0001 ; r = 0. 41, P 〈 0. 0001 respectively）, with a significant correlation between CRP and fibrinogen （r=0. 61, P 〈 0. 0001 ）. All three acute phase reactants showed a significant increase after CABG. After surgery, peak IL-6 was strongly correlated with peak CRP （r=0. 34, P =0.0009） but not with peak fibrinogen （r=0. 15, P =0. 13 ）, while peak CRP and peak fibrinogen were significantly correlated （r = 0. 15, P 〈 0. 0001 ）. HO-1 allelic repeats ranged from 22- 42, with （GT）25 and （GT）32 being the two most common alleles, and subsequently divided into three groups according to previous published work：〈 30 （GT） n were designated as S （short） , 30 - 37 （GT） n as M （middle） and long repeats with 〉 37 （GT） n as L （long） ; allele frequency 0. 35, 0. 58 and 0.07 respectively. Baseline CRP differed by genotype： those carrying at least one long allele having higher CRP than those with no long allele （3.76 ＋-0. 79 vs. 2. 07 ＋-0.

关键词： heine oxygenase polymorphism inflammation bypass surgery

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Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering:current evidence,clinical implications,and future perspectives

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Chinese Medical Journal 2023年第6期136卷 645-652页

作者： Xin Zhou Ziping Li Hangkuan Liu Yongle Li Dong Zhao Qing Yang Department of Cardiology Tianjin Medical University General HospitalTianjin 300052China Department of epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China

The clinical efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors(PCSK9i)in reducing major cardiovascular adverse events related to atherosclerotic cardiovascular disease(ASCVD)has been well established in recent large randomized outcome trials.Although the cardiovascular and all-cause mortality benefit of PCSK9i remains inconclusive,current cholesterol management guidelines have been modified toward more aggressive goals for lowering low-density lipoprotein cholesterol(LDL-C).Consequently,the emerging concept of"the lower the better"has become the paradigm of ASCVD prevention.However,there is evidence from observational studies of a U-shaped association between baseline LDL-C levels and all-cause mortality in population-based cohorts.Among East Asian populations,low LDL-C was associated with an increased risk for hemorrhagic stroke in patients not on antithrombotic therapy.Accumulating evidence showed that low LDL-C was associated with an enhanced bleeding risk in patients on dual antiplatelet therapy following percutaneous coronary intervention.Additionally,low LDL-C was associated with a higher risk for incident atrial fibrillation and thereby,a possible increase in the risk for intracranial hemorrhage after initiation of anticoagulation therapy.The mechanism of low-LDL-C-related bleeding risk has not been fully elucidated.This review summarizes recent evidence of low-LDL-C-related bleeding risk in patients on antithrombotic therapy and discusses potential measures for reducing this risk,underscoring the importance of carefully weighing the pros and cons of aggressive LDL-C lowering in patients on antithrombotic therapy.

关键词： Cholesterol-lowering drugs Bleeding Antithrombotic LDL cholesterol Proprotein convertase subtilisin/kexin type 9 inhibitors

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Temporal trend in mortality of cardiovascular diseases and its contribution to life expectancy increase in China, 2013 to 2018

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Chinese Medical Journal 2022年第17期135卷 2066-2075页

作者： Xue Xia Yue Cai Xiang Cui Ruixian Wu Fangchao Liu Keyong Huang Xueli Yang Xiangfeng Lu Shiyong Wu Dongfeng Gui Department of epidemiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Key Laboratory of cardiovascular epidemiology Chinese Academy of Medical SciencesBejing 100037China Center for Health Statistics and Information National Health CommissionBejing 100044China Department of Occupational and Environmental Health Tianjn Key Laboratory of EnvironmentNutrtion and Public HealthSchool of Public HealthTianjin Medical UniversityTianjin 300070China School of Medicine Southern University of Science and TechnologyShenzhenGuangdong 518055China

Backgrounds::cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate im

关键词： Aged cardiovascular diseases Causes of death Hemorrhagic stroke Ischemic stroke Longevity Mortality,premature Myocardial ischemia Life expectancy China

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Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

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Chinese Medical Journal 2022年第6期135卷 648-657页

作者： Junning Fan Zhijia Sun Canqing Yu Yu Guo Pei Pei Ling Yang Yiping Chen Huaidong Du Dianjianyi Sun Yuanjie Pang Jun Zhang Simon Gilbert Daniel Avery Junshi Chen Zhengming Chen Jun Lyu Liming Li On Behalf of the China Kadoorie Biobank Collaborative Group Department of epidemiology and Biostatistics School of Public HealthPeking UniversityBeijing 100191China Peking University Center for Public Health and Epidemic Preparedness and Response Peking UniversityBeijing 100191China National Clinical Research Center of cardiovascular Diseases National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China China Kadoorie Biobank National Coordination Centre Chinese Academy of Medical SciencesBeijing 100730China Nuffield Department of Population Health Medical Research Council Population Health Research UnitUniversity of OxfordOxford OX37LFUnited Kingdom Nuffield Department of Population Health University of OxfordClinical Trial Service Unit and Epidemiological Studies Unit(CTSU)Oxford OX37LFUnited Kingdom Suzhou Center for Disease Control and Prevention SuzhouJiangsu 215004China China National Center for Food Safety Risk Assessment Beijing 100022China Key Laboratory of Molecular cardiovascular Sciences Peking UniversityMinistry of EducationBeijing 100191China 不详

Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and d

关键词： Multimorbidity Pattern Mortality Chinese

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Development,validation and comparison of multivariable risk scores for prediction of total stroke and stroke types in Chinese adults:a prospective study of 0.5 million adults

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Stroke & Vascular Neurology 2022年第4期7卷 328-336,I0023-I0045页

作者： Matthew Chun Robert Clarke Tingting Zhu David Clifton Derrick A Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J Cairns 无 Clinical Trial Service unit and Epidemiological Studies Nuffield Department of Population HealthUniversity of OxfordOxfordUK Department of Engineering Science University of OxfordOxfordUK Department of Biomedical Engineering Oxford-Suzhou Centre for Advanced ResearchSuzhouChina Medical Research Council Health Research unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK CKB Project Department Fuwai Hospital Chinese Academy of Medical SciencesNational Center for Cardiovascular DiseasesBeijingChina CKB Project Department Chinese Academy of Medical SciencesBeijingChina Department of epidemiology and Biostatistics School of Public HealthPeking UniversityBeijingChina Department of epidemiology Peking University Center for Public Health and Epidemic Preparedness and ResponseBeijingChina On behalf of the China Kadoorie Biobank Collaborative Group

Background and purpose Low-income and middle-income countries have the greatest stroke burden,yet remain understudied.This study compared the utility of Framingham versus novel risk scores for prediction of total stroke and stroke types in Chinese adults.Methods China Kadoorie Biobank(CKB)is a prospective study of 512726 adults,aged 30-79 years,recruited from 10 areas in China in 2004-2008.By 1 January 2018,43234 incident first stroke cases(36310 ischaemic stroke(IS);8865 haemorrhagic stroke(HS))were recorded in 503842 participants with no history of stroke at baseline.We compared the predictive utility of the Framingham Stroke Risk Profile(FSRP)with novel CKB stroke risk scores and included recalibration,refitting,stratifying by study area and addition of other risk factors.Discrimination was assessed using area under the receiver operating characteristic curve(AUC)and calibration was assessed using Greenwood-Nam-D’Agostinoχ^(2) statistics.Results Incidence of total stroke varied fivefold by area in China.The FSRP had good discrimination for total stroke(AUC(95%CI);men:0.78(0.77 to 0.79),women:0.77(95%CI 0.76 to 0.78)),but poor calibration(χ^(2);men:1,825,women:3,053),substantially underestimating absolute risks.Recalibration reducedχ^(2) by>80%,but did not improve discrimination.Refitting the FSRP did not materially improve discrimination,but further improved calibration.Stratification by area improved discrimination(AUC;men:0.82(0.82 to 0.83);women:0.82(0.82 to 0.83)),but not calibration.Adding other risk factors yielded modest,but statistically significant,improvements in the AUCs.The findings for IS and HS were similar to those for total stroke.Conclusions The FSRP reliably differentiated Chinese adults with incident stroke,but substantially underestimated the absolute risks of stroke.Novel local risk prediction equations that took account of differences in stroke incidence within China enhanced risk prediction of total stroke and major stroke pathological types.

关键词： prediction income absolute

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