[An analysis of risk factors for ischemic stroke of different age and gender].

OBJECTIVE: To compare distribution difference in risk factors of patients with first-ever ischemic stroke (IS) of different age and gender. METHODS: A total of 1027 patients admitted to the neurological department in Shanghai Renji Hospital with first-ever IS were recruited and divided into young adult group (< 50 years old), middle-aged group (50 - 80 years old), and very old group (> 80 years old) according to their ages. Risk factor analysis included history of smoking, high alcohol consumption, hypertension (HT), diabetes mellitus (DM), heart diseases, atrial fibrillation (AF) and family history of cardiovascular diseases. RESULTS: Female patients were globally older than male patients (71.1 vs 65.7, P < 0.001) at the first attack of IS and having higher prevalence of DM (26.8% vs 19.2%, P = 0.004), heart diseases (28.8% vs 19.2%, P < 0.001) and AF (7.6% vs 3.9%, P = 0.009). However, female patients were less likely to drink heavily (1.0% vs 31.6%, P < 0.001) or smoke (4.4% vs 59.9%, P < 0.001) than the male patients. The rates of smoking and heavy drinking in young adult group were higher than that in other two groups. Patients in very old group had higher prevalence of heart diseases and AF but lower proportion of positive family cardiovascular diseases history than patients in other two groups. HT and DM were equally frequent among three groups. In young adult group, female patients were more likely to have heart diseases and family history of heart diseases (P = 0.015 and P = 0.048). In middle-old group, HT, DM, heart disease and AF were more common in women than in men (P = 0.021, P = 0.004, P = 0.001 and P = 0.039). CONCLUSION: There are differences in risk factor distribution in patients with first-ever IS of different age and gender. Therefore, screening and health education should be performed in allusion to different risk factors.

[Impacts of stroke clinics on the utilization of statins for secondary prevention of ischemic stroke].

OBJECTIVE: To describe the impact of stroke clinic on the usage of statins for secondary prevention of ischemic stroke. METHODS: Data about the demography, social economic status, personal histories, blood lipid profiles, and the status of the usage of statins from 568 serial ischemic stroke patients were retrospectively analysed. RESULTS: A total of 51.3% patients followed up in stroke clinic (306 patients) and 7.6% patients followed up in general clinic (262 patients) were treated with statins. 71.6% patients with and 44.8% patients without hyperlipidemia in stroke clinics were taking statins, which were higher than that patients in the general clinics (27.1% and 2.0% respectively). The patients in the stroke clinics with high LDL-C level (>3.4 mmol/L) were more likely to be treated with statins than those with lower level (25.6% vs 14.7%, P=0.017). CONCLUSIONS: The rate of statins usage is extremely low in stroke patients followed up in a general clinic, but it can been improved greatly in a stroke clinic. Stroke clinic can narrow the gap between the clinical practice and the guideline for secondary prevention of ischemic stroke.

[The prevalence and risk factors for cognitive impairment following ischemic stroke].

OBJECTIVES: To identify the prevalence and risk factors that were associated with post-stroke cognitive impairment (PSCI) among a large cohort of consecutive ischemic stroke patients. METHODS: 526 consecutive patients, who had suffered from ischemic stroke 3 months ago were recruited in this study. Patients were classified as having no cognitive impairment (NCI), cognitive impairment but no dementia (CIND) and vascular dementia (VaD) according to their cognitive function. They were also categorized as with subcortical ischemic vascular diseases (SIVD) or cortical ischemic vascular diseases (CIVD) with neuroimaging findings. Their demographic data, vascular risk factors and stroke characteristics were also documented. RESULTS: The overall prevalence of PSCI (CIND + VaD) was 36.7%. Compared with the NCI subjects, PSCI subjects were older, more dominant femininely, less educated, with more cases of right hemi-paralysis and higher depression scores, but did not have more specific vascular risk factor. Separately, VaD patients demonstrated lower economic level, less spouse-caring, more prevalence of dysphasia, higher rate of incontinence and more cases with CIVD, while CIND patients had more cases with SIVD. The VaD patients had more cortical lesions and lower depression scores than the CIND patients. On logistic regression analysis, older age, female gender, lower economic level, dysphasia, SIVD, CIVD and higher depression scores were independent risk factors for PSCI. CONCLUSION: PSCI is common among ischemic stroke patients and related to demographic factors, stroke types, and depression.

[The impact of stroke clinic on improving the compliance with the guidelines for secondary prevention of ischemic stroke].

OBJECTIVE: With the physician training program and stroke clinic, the gap between clinical practice and the guideline for secondary prevention of ischemic stroke can been narrowed. METHODS: 305 patients with ischemic stroke were enrolled in a stroke clinic after their discharge from the hospital. Among the 305 patients, 87 were discharged before the institution of a physician training program (pre-training group) and 218 after the institution (post-training group). Their usage of antithrombotic agents, statins, non-standardized therapies and antihypertensive agents were compared at the time of discharge from the hospital and follow-up in the stroke clinic comparison was also made for the two groups of patients discharged before and after the physician training program. RESULTS: After the physician training program, implementation rates increased for antithrombotic agents (79.3% vs 93.1%, P < 0.01) and statins (19.5% vs 59.2%, P < 0.01), using of non-standardized therapies decreased (47.1% vs 27.5%, P = 0.001), but no change was found for using of antihypertensive agents (88.4% vs 94.0%, P > 0.05). Comparing with the usage of medications at the time of discharge, the usage of antithrombotic agents and statins after discharge i,e. in the stroke clinic were further increased (for antithrombotics, in the pre-training group 79.3% vs 86.2%, P = 0.229, in the post-training group 93.1% vs 94.0%, P = 0.696; for statins, in the pre-training group 19.5% vs 39.1%, P = 0.005, in the post-training group 59.2% vs 69.7%, P = 0.021), while the usage of non-standardized therapies decreased further (in the pre-training group 47.1% vs 17.2%, P < 0.01, in the post-training group 27.5% vs 14.2%, P = 0.001). Implement of guideline at discharge influenced the compliance as the patients with high rates of usage of antithrombotic agents and statins at the time of discharge had also high rates of the usage of them at follow-up in the stroke clinic. CONCLUSIONS: Physician training program increases the implement of the guideline for secondary stroke prevention and stroke clinic can improve the compliance with it. Usage of medications at the time of discharge influences the compliance with them during the follow-up period.

Age- and gender-specific prevalence of risk factors in patients with first-ever ischemic stroke in china.

Background. Evidences are accumulating that age and gender have great impact on the distribution of stroke risk factors. Such data are lacking in Chinese population. Methods. 1027 patients with first-ever ischemic stroke (IS) were recruited and divided into young adult (<50 years), middle-aged (50∼80 years), and very old (>80 years) groups according to stroke onset ages. Vascular risk factors were collected and compared among groups. Results. Female patients were globally older than male patients at stroke onset and having higher prevalence of diabetes mellitus (DM), heart diseases, and atrial fibrillation (AF). However, females were less likely to drink heavily or smoke than males. Young patients had a much higher proportion of smoking and drinking than middle-aged and very old patients and the highest family history of hypertension, while very old patients had the highest prevalence of heart diseases and AF but lowest proportion of positive family history of vascular diseases. Hypertension and DM were equally frequent among three groups. Conclusion. Our study showed that vascular risk factors had a specific age and gender distribution pattern in Chinese IS patients. Secondary prevention strategy should emphasize on the control of different risk factors based on patient's age and gender.