Assessment of the Risk of Malnutrition or Frailty Among Patients Undergoing Liver Transplantation: A Hospital-Based Prospective Study.

Objective: We aimed to explore the status of nutritional and frailty in patients undergoing liver transplantation and the associated influencing factors. Methods: We conducted a follow-up analysis of 44 patients who underwent liver transplantation between 2021 and 2022. We followed up and recorded the nutritional status and risk of weakness at different time-points (days 1, 2, 3, 6, 9, and 12) postoperatively. Patient information regarding demographics, physical examination, medical history, and perioperative blood tests were collected. Binary logistic regression was applied to identify risk factors for weakness after liver transplantation. Results: The cohort comprised 44 liver transplant recipients, with a mean age of 47.66 years (standard deviation=9.49 years). Initial analysis revealed that, compared to the group without nutritional risks, the group with nutritional risks displayed elevated age and preoperative blood ammonia levels one week post-surgery. Moreover, this group had reduced levels of albumin and total bile acid preoperatively. Patients with preoperative nutritional risks were also prone to similar risks 2 weeks postoperatively. Further, a correlation was observed between preoperative pulmonary infections and increased frailty risk 6 days postoperatively. At both 9 and 12 days postoperatively, patients with frailty risk exhibited higher preoperative white blood cell counts and ammonia levels than those without. Multivariable analysis, controlling for confounding factors, indicated a significant association between preoperative nutritional status and nutritional risk 2 weeks postoperatively, as well as a link between preoperative white blood cell count and frailty risk at 12 days postoperatively. Conclusion: There was a significant correlation between preoperative nutritional status and nutritional risk 2 weeks after liver transplantation, and preoperative white blood cell count was an independent risk factor for weakness 12 days postoperatively. Preoperative nutritional management for patients could potentially mitigate the likelihood of adverse clinical outcomes.

Perioperative safety assessment of patients undergoing unilateral or bilateral hip replacements.

Introduction: Due to the aging of the world population and the increase of obesity rate, it is expected that the number of joint replacement surgery will continue to increase in the next few years. This study evaluated the safety differences between unilateral and bilateral hip replacement surgeries. Methods: The data for patients who underwent hip arthroplasty in 2021 and 2022 were examined. The data set included 68 patients who were grouped according to the type of hip replacement needed, sex, age, and body mass index. Total blood loss and operative time were the safety-related indicators used to compare the groups. Results: Regardless of whether the unilateral replacement group was compared with the overall bilateral replacement group or separately with the staged and simultaneous bilateral replacement groups, simultaneous bilateral replacement surgeries were equally safe as the other types of hip replacements. The total blood loss and operative time for the simultaneous bilateral replacement group were not significantly different from those in the unilateral and staged bilateral replacement groups. For overweight patients, the operative time for simultaneous bilateral replacements was significantly shorter than that for unilateral replacements. Conclusions: These findings suggest that for patients requiring bilateral hip replacements, the blood loss risk for patients undergoing simultaneous bilateral hip replacements was similar to that for patients undergoing either unilateral or staged bilateral hip replacements. Thus, simultaneous bilateral total hip replacement (THR) are safe and should be considered for candidate patients.

Short-term Effectiveness of a Modified Osteotomy for Total Elbow Joint Replacement in Patients of Hemophilic Elbow Arthritis with Severe Flexion Contracture Deformity: A Three-Cases Series Report.

OBJECTIVE: To report the modified osteotomy and the short-term effectiveness of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity. METHODS: This study introduced the therapeutic approach of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity, and assessed the short-term effectiveness in three cases (three elbows) of end-stage hemophilic elbow arthritis admitted from October 2020 to December 2020. The included patients were all diagnosed with hemophilia A (factor VII deficiency), accompanied by severe bilateral elbow joint flexion contracture, which seriously affects daily life and requires surgical intervention. Clinical data and follow-up results were analyzed before total elbow arthroplasty and 1, 3, and 6 months postoperatively. Pre- and postoperative range of motion, pain score, and function score were compared, and intraoperative and postoperative complications are reported. RESULTS: All three patients were male, with an average age of 31 years. The main clinical manifestations were bilateral elbow arthritis with flexion contracture. Two of the patients underwent right elbow replacement, and one patient underwent left elbow replacement. All cases were followed up for 6 months postoperatively. No incision infection or ulnar nerve injury occurred. Postoperative triceps brachii muscle strength was slightly weakened compared with preoperative muscle strength. Average elbow flexion and extension range of motion was 60° (30°-100°) preoperatively and increased to 127° (110°-140°) postoperatively; rotational range of motion of the affected forearm was 47° (10°-85°) preoperatively and increased to 117° postoperatively. The mean visual analogue scale (VAS) was 6 (5-8) preoperatively and decreased to 3 (2-4) postoperatively. The mean MEPS score was 62 (55-75) and increased to 87 (80-95) postoperatively. During the follow-up, anteroposterior and lateral radiographs showed no signs of prosthesis loosening in the elbow. CONCLUSIONS: For severe hemophilic elbow arthritis patients, the short-term treatment effect of total elbow replacement is good, following the strict adherence to the surgical indications and proper preparation for the perioperative period. The modified osteotomy can fully expose the visual field and reduce complications of ulnar nerve injury. The long-term effects need to be study future.

Burden of Metabolic Syndrome Among a Low-Income Population in China: A Population-Based Cross-Sectional Study.

Introduction: Metabolic syndrome (MetS) is a chronic and complex disease associated with all-cause mortality, cardiovascular disease, and type 2 diabetes. The present study aimed to evaluate the prevalence of MetS and its risk factors among middle-aged and older adults in low-income, low-education rural areas with a high incidence of stroke. Methods: This cross-sectional study of the general population was performed from April 2019 to June 2019 in rural areas of Tianjin, China. All eligible residents aged ≥ 45 years and without active malignant tumors, hepatic failure, and severe renal disease underwent routine medical examinations, which included a questionnaire, physical examination, and routine blood and biochemical tests. The modified International Diabetes Federation criteria for the Asian population was used to identify patients with MetS. Results: A total of 3175 individuals (44.8% men, 55.2% women) were included in the final analysis. The prevalence of MetS was 52.8%, with higher prevalence in women than in men (62.4%and 40.9%, respectively). Of the five MetS components, high blood pressure and abdominal obesity were the two most prevalent in both women and men, accounting for 89.3% and 62.0%, respectively, followed by elevated fasting plasma glucose, low high-density lipoprotein cholesterol, and elevated triglycerides. Multivariate logistic regression analysis revealed the following traits to be risk factors for MetS: female sex, self-reported smoking, self-reported snoring, high body mass index, high waist-to-hip ratio, and high serum urate level. Conclusion: The prevalence of MetS was quite high in rural areas with a low-income, low-education population. Implementing preventive and therapeutic interventions based on these risk factors is essential to prevent metabolic abnormalities.

Sex-Specific Risk Factors Associated with Helicobacter pylori Infection Among Individuals Undergoing Health Examinations in China.

Purpose: Helicobacter pylori is one of the most common causes of peptic ulcers, gastritis, and gastric cancers. This study investigated sex-specific differences in the prevalence of H. pylori infection and its associated factors among individuals undergoing hospital-based health examinations in southern China. Methods: This study enrolled consecutive healthy individuals who underwent regular health examinations at a hospital physical examination center between September 2020 and September 2021. Anthropometric characteristics and biochemical profiles were measured. All individuals underwent carbon-13 urea breath tests. Univariate and multivariate analyses were used to evaluate the factors associated with H. pylori infection. Results: A total of 5035 individuals (men, 59.1%; women, 40.9%) were included in the analyses. The total rate of H. pylori infection was 35.0% (men, 35.5%; women, 34.3%). In the multivariate analysis, the risk factors identified for H. pylori infections were high fasting blood glucose levels and blood pressure ≥160 mmHg in men and older age, high body mass index, and low albumin levels in women. Conclusion: These findings suggest that physicians must be aware of the metabolic factors associated with H. pylori infections in the Chinese population. Early detection of these factors and timely intervention are expected to reduce H. pylori infections and provide a theoretical basis for the primary prevention of several gastrointestinal diseases.

Perioperative blood loss during joint replacement: comparison between patients with and without hemophilia.

BACKGROUND: Although arthroplasty provides satisfactory pain relief, functional improvement, and reduced flexion contracture in patients with hemophilia arthropathy, bleeding remains the primary problem associated with hemophilic arthropathy joint replacement. We aimed to explore the differences in perioperative blood loss (PBL) associated with joint replacement surgery in patients with and without hemophilia. METHODS: This study retrospectively analyzed 61 cases of PBL in patients undergoing joint replacement surgery, including 37 patients with hemophilia and 24 patients without hemophilia. All patients demonstrated severe joint flexion contractures that seriously affected their daily lives and required surgical intervention. PBL was compared between the two groups. RESULTS: In univariate analysis, the overall (p < 0.001) and hidden (p < 0.001) blood losses were significantly higher for patients with hemophilia than those for patients without hemophilia. However, after adjustment for multiple factors, there was no significant difference in overall blood loss between the two groups (p = 0.731). In addition, sex, age group, and surgical site did not affect blood loss in patients with hemophilia. CONCLUSION: Overt bleeding did not increase significantly in patients with hemophilia, compared with that in patients without hemophilia. In terms of blood loss, joint replacement surgery for patients with hemophilia is relatively safe. The results of this study must be verified by a prospective follow-up study with larger sample size. Trial registration Retrospectively registered.

HIV infection is not associated with perioperative blood loss in patients undergoing total hip arthroplasty.

BACKGROUND: Patients with HIV have a higher prevalence of thrombocytopenia than those without HIV infection, increasing their risk of substantial perioperative blood loss (PBL) during total hip arthroplasty (THA). This study aimed to evaluate PBL risk factors in HIV-infected patients undergoing THA. METHODS: Eighteen HIV+ patients (21 hip joints) and 33 HIV- patients (36 joints) undergoing THA were enrolled in this study. PBL was calculated using the Gross equation, which comprises total blood loss (TBL), dominant blood loss (DBL), and hidden blood loss (HBL). Risk factors for post-THA PBL in both patient populations was evaluated using multivariable linear regression. RESULTS: At baseline, the HIV+ patients were younger, more likely to be male and to have elevated hemoglobin and albumin levels, and lower erythrocyte sedimentation rates than HIV- patients. There were no differences in the T-lymphocyte subsets or coagulation function between the two groups. Age and albumin level were identified as potential HBL risk factors after THA, and albumin level was associated with higher TBL. The unadjusted linear regression analysis showed that the HBL and TBL were significantly higher in HIV+ patients than in HIV- patients. However, after adjusting for other factors, no differences in DBL, HBL, or TBL were observed between HIV- and HIV+ patients. CONCLUSION: PBL was similar in both groups undergoing THA, regardless of their HIV-infection status. THA surgery is a safe and effective procedure in HIV+ patients.

Sex-related associations between body height and cognitive impairment among low-income elderly adults in rural China: a population-based cross-sectional study.

BACKGROUND: Body height is a marker of childhood health and cumulative net nutrition during growth periods. However, sex-specific associations between body height and cognitive impairment are not well known in northern rural China. METHODS: We assessed sex differences in the association between body height and cognitive impairment in a low-income elderly population in rural China. A population-based cross-sectional study was conducted from April 2014 to August 2014 to collect basic information from elderly residents aged 60 years and older in rural areas of Tianjin, China. Body height and Mini Mental State Examination (MMSE) scores were measured, and the relationships between these variables were assessed. RESULTS: A total of 1081 residents with a mean age of 67.7 years were enrolled in this study. After adjusting for age, educational attainment, smoking status, drinking status, and the presence of hypertension, diabetes, and hypercholesterolemia, higher body height was found to be associated with a decreased prevalence of cognitive impairment in elderly men. Each 1-dm increase in height was associated with a 37% decrease in the prevalence of cognitive impairment. However, there was no significant association between body height and cognitive impairment among elderly women. CONCLUSION: In conclusion, shorter body height was related to cognitive impairment independently of age, educational attainment, lifestyle factors, and health-related comorbid factors among low-income elderly men in rural China. Accordingly, shorter elderly men may be targeted for effective dementia prevention in rural China.

Association of Hearing Acuity and Cognitive Function Among a Low-Income Elderly Population in Rural China: A Population-Based Cross-Sectional Study.

Hearing loss is a modifiable risk factor for dementia and cognitive decline. However, the association between cognition and hearing acuity at different frequencies is unknown. We aimed to assess the relationships between hearing acuity at different frequencies with global cognitive function and five domains of cognition among a low-income elderly population in northern rural China. A population-based cross-sectional study was conducted to collect basic information from elderly residents aged 60 years and older in rural areas of Tianjin, China from April 2012 to November 2013. Pure tone averages (PTAs) at different frequencies in the ear with better hearing and Mini-Mental State Examination (MMSE) scores were measured, and the relationships between these variables were assessed. A total of 737 residents aged 60 years or more were enrolled in this study, and the prevalence of hearing impairment was 60.7%. After adjusting for sex, age, education, income, smoking, drinking, systolic blood pressure (SBP), total cholesterol (TC), and low-density lipoprotein cholesterol level (LDL-C), MMSE score and immediate recall score were negatively associated with overall PTA (OPTA) at four frequencies (0.5, 1, 2, and 4 kHz), PTA at low frequencies (LPTA; 0.5, 1, and 2 kHz), and PTA at high frequencies (HPTA; 3, 4, and 8 kHz) in the ear with better hearing. Moreover, orientation score was negatively associated with OPTA and LPTA, and the attention and calculation scores were negatively associated with OPTA and HPTA. Each 10-dB increase in OPTA was associated with a MMSE score decrease of 0.464. Each 10-dB increase in LPTA or HPTA was associated with a MMSE score decrease of 0.441 (95% CI: -0.795, -0.086) and 0.351 (95% CI: -0.592, -0.110), respectively. The present study demonstrated significant but weak relationships between OPTA, LPTA, and HPTA with global cognitive function, as defined using MMSE scores; these relationships were independent of age, education, lifestyle factors, and laboratory test values. These results indicated that hearing was associated with cognitive decline among older individuals, who should be screened routinely to identify risk for cognitive decline.

Sex Differences in the Association Between Obesity and Cognitive Impairment in a Low-Income Elderly Population in Rural China: A Population-Based Cross-Sectional Study.

Background: Obesity is a potentially modifiable risk factor for cognitive impairment. However, sex-specific relationships between obesity and cognitive impairment in late life remain unclear. Objective: We aimed to assess sex differences in the association between various obesity parameters and cognitive impairment in a low-income elderly population in rural China. Methods: A population-based cross-sectional study was conducted to collect basic information from elderly residents aged 60 years and older from April 2014 to August 2014 in rural areas of Tianjin, China. Obesity parameters, including body mass index (BMI) and waist circumference (WC), and Mini Mental State Examination scores were measured, and the relationships between these variables were assessed. Results: A total of 1,081 residents with a mean age of 67.70 years were enrolled in this study. After adjusting for age, educational attainment, smoking status, drinking status, physical exercise participation, and the presence of diabetes and hyperlipidemia, blood pressure group; a high BMI was found to be associated with an increased prevalence of cognitive impairment in elderly women. Each 1-unit increase in BMI was associated with a 5.9% increase in the prevalence of cognitive impairment. WC was related to the prevalence of cognitive impairment in elderly men, and each 1-cm increase in WC was associated with a 4.0% decrease in the prevalence of cognitive impairment. However, there were no significant associations between WC and cognitive function in women or between BMI and cognitive impairment in men. Conclusion: A greater WC was positively associated with better cognitive function in low-income elderly men in rural China, whereas a higher BMI was associated with an increased risk of cognitive impairment in elderly women, independent of sociodemographic, lifestyle, and health-related comorbid factors. Our results suggest weight management of elderly women in rural China may have cognitive benefits. However, randomized controlled trials would be needed to confirm causality.

Sex-specific differences in the prevalence of and risk factors for hyperuricemia among a low-income population in China: a cross-sectional study.

Objectives: China has already entered the aging society, and its aging population is the largest worldwide. Accordingly, several aging-related conditions including hyperuricemia are becoming a public health concern owing to their increasing prevalence in rural areas. However, the sex-specific differences in the risk factors for hyperuricemia among the middle-aged and elderly in rural North China are unclear. Thus, this study aimed to evaluate sex-specific differences in the prevalence of and risk factors for hyperuricemia in low-income adults in rural North China. Methods: This population-based cross-sectional study recruited participants aged ≥50 years from the Tianjin Brain Study between April and August 2019. After excluding those who had cancer, severe psychiatric disturbances, hepatic failure, and serious renal disease (i.e., an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m2), 3119 (1392 men and 1727 women) eligible participants were included. Basic information and blood samples were collected, and data were analyzed using logistic regression models. Results: Hyperuricemia was prevalent in 14.4% (men, 14.2%; women, 14.5%)of the participants, and the prevalence significantly increased with increasing age in both sexes (male, P= 0.034; female, P< 0.001). In multivariate analysis, obesity, metabolic syndrome, and high levels of total cholesterol, 2 h plasma glucose, and blood urea nitrogen were risk factors for hyperuricemia in both men and women. Physical activity was a risk factor in men, while a high white blood cell count was a risk factor in women. A high eGFR was a protective factor in both sexes. Conclusions: Hyperuricemia was highly prevalent in low-income adults in Tianjin, with men and women showing differences in risk profiles and comorbidities. Early management of hyperuricemia according to sex-specific risk factors should be considered in primary care to reduce the prevalence and burden of hyperuricemia in rural China.

Rate and Determinants of Recurrence at 1 Year and 5 Years After Stroke in a Low-Income Population in Rural China.

Recurrent stroke is becoming an increasingly important public health issue owing to the increased risk of disability and death. However, population-based studies investigating the rate of recurrent stroke in China are rare. We explored the rate and determinants of recurrent stroke within 1 and 5 years after the initial stroke in a rural population in China. Data for stroke events were obtained from the Tianjin Brain Study, conducted between 1992 and 2016. The age-standardized rates of recurrent stroke within the first year and the first 5 years after the initial stroke were calculated for this period. Determinants of recurrent stroke were assessed using Cox regression analyses. The overall age-standardized rate of recurrent stroke within 1 year was 5.7% (men, 6.9%; women, 4.6%); within 5 years, the overall recurrent stroke rate was 22.5% (men, 24.0%; women, 20.2%). The recurrence rate increased with advancing age and decreased with increased educational attainment. Age ≥65 years and a history of alcohol consumption were independent risk factors for recurrent stroke within 1 year after the incident stroke, after adjusting for age, sex, education, hypertension, diabetes, smoking, and alcohol consumption. However, the risk of recurrent stroke within 5 years after the incident stroke was positively associated with male sex, age ≥65 years, a lower level of education, known diabetes, and alcohol consumption, after adjusting for the previously indicated covariates. These findings suggest a crucial need to address risk factor management among stroke patients to reduce the burden of stroke, especially among low-income populations. Furthermore, a multicenter, large sample, nationwide study is urgently needed.

Trends in the prevalence, awareness, treatment and control of diabetes in rural areas of northern China from 1992 to 2011.

AIMS/INTRODUCTION: The worldwide prevalence of diabetes mellitus has been increasing over the past decades, particularly in developing countries. Because of the lack of information regarding changes in diabetes mellitus prevalence, awareness, treatment and control in rural China, we assessed these trends - overall and in the context of related health conditions - to explore the impact of these primary health issues on these rates in a poorly educated, rural population. MATERIALS AND METHODS: Diabetes mellitus prevalence, awareness, treatment and control rates were compared between two surveys carried out in 1992 and 2011. The residents of three villages, aged 35-64 years, were recruited for this study. RESULTS: In 1992, 1,091 individuals were interviewed and, in 2011, 2,338 individuals were interviewed. Between the two surveys, the overall diabetes mellitus prevalence in the study population was lower in 1992 than that in 2011 (P < 0.001); among men, the prevalence was 5.2-fold higher in 2011 than in 1992 (10.5 vs 1.7%) and nearly 4.3-fold higher (11.2 vs 2.1%) among women. Men aged 35-44 years, with >6 years of education, stage I hypertension and being overweight, had a higher prevalence of diabetes mellitus in 2011 than in 1992. Similarly, for the same time periods, there was also a higher diabetes mellitus prevalence among women aged 55-64 years, with 1-6 years of education, stage III hypertension and who were overweight. However, there were no significant changes in diabetes mellitus awareness, treatment or control in this population. CONCLUSIONS: These results suggest that particular efforts must be made to enhance diabetes mellitus prevention, control and public awareness in rural communities in China.

Age- and Sex-Associated Impacts of Body Mass Index on Stroke Type Risk: A 27-Year Prospective Cohort Study in a Low-Income Population in China.

The relationship between body mass index (BMI) and stroke type has remained controversial despite studies demonstrating that BMI is related to stroke risk, especially in specific groups. We assessed the age- and sex-associated impacts of BMI on stroke type in a low-income, poorly educated population in China. The association of BMI with stroke type was estimated using Cox regression analyses in this prospective cohort study, after adjusting for sex, age, education level, hypertension, diabetes, smoking, and alcohol drinking status. During the follow-up period, 638 stroke cases occurred among the 3,906 participants included in this prospective study. For men aged <65 years, being overweight was an independent predictor of all stroke subtypes, compared with normal-weight individuals; the hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.98 (1.52-2.58) for total stroke, 1.69 (1.22-2.33) for ischemic stroke, and 3.62 (2.09-6.25) for hemorrhagic stroke, all P < 0.001. Being underweight was also an independent predictor of hemorrhagic stroke (HR, 5.10; 95%CI, 1.80-14.50, P = 0.002). For women <65-years-old, being overweight was a risk factor for total (HR, 1.38; 95% CI, 1.01-1.89; P = 0.044) and hemorrhagic strokes (HR, 2.06; 95% CI, 1.00-4.28; P = 0.050); obesity was a risk factor for total (HR, 2.47; 95% CI, 1.60-3.82) and ischemic strokes (HR, 2.53; 95% CI, 1.54-4.15), all P < 0.001. These findings suggest that weight management should be a high priority for substantially reducing the heavy burden of strokes in rural China among both men and women <65-years-old; men<65-years-old should maintain their weight within a reasonable range.

Determinants of Developing Stroke Among Low-Income, Rural Residents: A 27-Year Population-Based, Prospective Cohort Study in Northern China.

Although strokes are the leading cause of death and disability in many countries, China still lacks long-term monitoring data on stroke incidence and risk factors. This study explored stroke risk factors in a low-income, rural population in China. The study population was derived from the Tianjin Brain Study, a population-based stroke monitoring study that began in 1985. This study documented the demographic characteristics, past medical histories, and personal lifestyles of the study participants. In addition, physical examinations, including measurements of blood pressure (BP), height, and weight, were performed. Hazard ratios (HRs) were estimated for the risk factors for all subtypes of stroke using multivariate Cox regression analyses. During the study with mean following-up time of 23.16 years, 3906 individuals were recruited at baseline, and during 27 years of follow-up, 638 strokes were documented. The multivariate Cox regression analyses revealed a positive correlation between age and stroke incidence. Limited education was associated with a 1.9-fold increase in stroke risk (lowest vs. highest education level). Stroke risk was higher among former smokers than among current smokers (HR, 1.8 vs. 1.6; both, P < 0.05). Moreover, stroke risk was significantly associated with sex (HR, 1.8), former alcohol drinking (HR, 2.7), baseline hypertension (HR, 3.1), and overweight (HR, 1.3). In conclusion, this study identified uncontrollable (sex and age) and controllable (education, smoking, alcohol drinking, hypertension, and overweight) risk factors for stroke in a low-income, rural population in China. Therefore, it is critical to control BP and weight effectively, advocate cessation of smoking/alcohol drinking, and enhance the education level in this population to prevent increase in the burden of stroke in China.

Sex differences in outcomes and associated factors among stroke patients with small artery occlusion in China.

BACKGROUND: Sex differences in outcomes after small artery occlusion (SAO) stroke have not been well described, particularly in a Chinese population. We aimed to assess sex differences in outcomes and related risk factors among patients with SAO. METHODS: All consecutive patients with SAO were recruited between May 2005 and September 2014. Clinical features and risk factors were recorded. The mortality, recurrence, and dependency rates at 3 months after stroke were assessed. RESULTS: A total of 2524 patients with SAO were included in this study. There was a higher frequency of mild stroke, current smoking, and alcohol consumption in men than in women. Women were more likely than men to be older, to have diabetes and obesity, and to have higher total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. There were worse outcomes in men than in women at 3 months after stroke (P < 0.05). There were more independent risk factors of poor outcome in men than in women. Older age was a common predictive factor of outcome both in men and in women. In men, low triglyceride levels and high fasting plasma glucose levels were independent risk factors for mortality; in addition, a high low-density lipoprotein cholesterol level was associated with recurrence. Moreover, in men, moderate and severe stroke, and high total cholesterol and fasting plasma glucose levels were risk factors for dependency. A negative association was found between low-density lipoprotein cholesterol level and risk of mortality and between total cholesterol level and risk of recurrence in women. CONCLUSIONS: These findings suggest that it is crucial to control conventional risk factors and fasting plasma glucose and lipid levels among patients with SAO, especially male patients, to reduce the burden of stroke in China.

Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China.

Epidemiological studies have reported associations between traditional cardiovascular risk factors and carotid intima-media thickness (CIMT) or carotid plaque. However, definite risk factors at different phases of carotid atherosclerosis remain controversial. We aimed to explore risk factors and characteristics of carotid atherosclerosis at different stages in a low-income population with a high incidence of stroke in China. Between April 2014 and January 2015, we recruited 3789 stroke-free and cardiovascular disease-free residents aged ≥ 45 years. B-mode ultrasonography was performed to measure CIMT and the presence of carotid plaque. Traditional risk factors were compared between the increased CIMT group and normal CIMT group, and between those with and without carotid plaque. A total of 3789 participants were assessed in this study, with a mean age (standard deviation) of 59.92 (9.70) years. The prevalence of increased CIMT and carotid plaque increased with older age and higher education levels. Age, hypertension, diabetes, and high low-density lipoprotein cholesterol levels were risk factors for increased CIMT and carotid plaque. Furthermore, compared to never smoking, passive smoking was positively associated with increased CIMT, with an odds ratio (95% confidence interval) of 1.26 (1.05, 1.53; P = 0.016); high body mass index was an obvious protective factor against carotid plaque, with an odds ratio (95% confidence interval) of 0.97 (0.95, 0.99; P = 0.004). It is important to identify factors associated with atherosclerosis to prevent cardiovascular disease and stroke and reduce the burden of stroke in this high-risk population.

Association between carotid intima-media thickness and fasting blood glucose level: A population-based cross-sectional study among low-income adults in rural China.

AIMS/INTRODUCTION: Carotid intima-media thickness (CIMT) is an established predictor of cardiovascular disease and stroke. We aimed to identify the association between CIMT and blood glucose, as well as the risk factors associated with increased CIMT in a low-income Chinese population. MATERIALS AND METHODS: Stroke-free and cardiovascular disease-free residents aged ≥45 years were recruited. B-mode ultrasonography was carried out to measure CIMT. RESULTS: There were 2,643 participants (71.0%) in the normal group, 549 (14.7%) in the impaired fasting glucose group and 533 (14.3%) in the diabetes mellitus group. The determinants of increased CIMT were older age; male sex; low education; hypertension; smoking; high levels of systolic blood pressure, fasting blood glucose and low-density lipoprotein cholesterol; and low levels of diastolic blood pressure, triglycerides and high-density lipoprotein cholesterol, after adjusting for covariates. Age and hypertension were the common risk factors for increased CIMT in all three groups. Furthermore, male sex, smoking and high low-density lipoprotein cholesterol level were positively associated with the mean CIMT in the normal group; high triglycerides levels were negatively associated with the mean CIMT in the impaired fasting glucose group; and alcohol consumption was an independent risk factor for mean CIMT in the diabetes mellitus group. Hypertension was the greatest risk factor for increased CIMT. CONCLUSIONS: These findings suggest that it is crucial to manage and control traditional risk factors in low-income populations in China in order to decelerate the recent dramatic increase in stroke incidence, and to reduce the burden of stroke.

Carotid Intima-media Thickness and its Association with Conventional Risk Factors in Low-income Adults: A Population-based Cross-Sectional Study in China.

Carotid intima-media thickness (CIMT) is an established predictor of cardiovascular disease and stroke. However, risk factors associated with CIMT remain unclear. Therefore, we aimed to identify factors associated with CIMT in a low-income Chinese population. Stroke-free and cardiovascular disease-free residents aged ≥45 years were recruited. B-mode ultrasonography was performed to measure CIMT. The mean age of participants (n = 3789) was 59.92 years overall, 61.13 years in men, and 59.07 years in women (P < 0.001). Male sex, older age, low education level, smoking, hypertension, and high systolic blood pressure, fasting blood glucose, and low-density lipoprotein cholesterol levels were independent determinants of mean CIMT. Mean CIMT was higher by 18.07 × 10-3 mm in hypertensive compared to normotensive participants (P < 0.001), by 19.03 × 10-3 mm in men compared to women (P < 0.001), and by 9.82 × 10-3 mm in smokers compared to never smokers (P < 0.001). However, mean CIMT decreased by 1.07, 0.37, and 2.36 × 10-3 mm per 1-unit increase in education level, diastolic blood pressure, and triglycerides, respectively. It is important to manage conventional risk factors in low-income populations to decrease stroke incidence.

The association between elevated fasting plasma glucose levels and carotid intima-media thickness in non-diabetic adults: a population-based cross-sectional study.

We assessed the association between the mean carotid intima-media thickness (CIMT) and fasting plasma glucose (FPG) levels in a low-income population in rural China. Adults aged ≥45 years without a history of diabetes, stroke, or cardiovascular disease were recruited. All participants were categorized into four groups according to FPG level. A total of 3509 participants were analyzed in this study. In the univariate analysis, sex, age, education level, hypertension, central obesity, current smoking, alcohol consumption, and higher levels of FPG, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were associated with mean CIMT and frequency of increased CIMT. FPG levels were significantly associated with mean CIMT; each 1-mmol/L increase in FPG resulted in a 2.75-µm increase in mean CIMT when adjusted by age, sex, education level, current smoking status, alcohol consumption, hypertension, and the levels of TC, TG, HDL-C, and LDL-C (P = 0.044). However, the association between FPG and the frequency of increased CIMT disappeared after adjusting by covariates. These findings indicate that FPG is an independent determinant of mean CIMT in a non-diabetic population. Management and control of FPG levels is crucial for preventing atherosclerosis in populations with high stroke risks in China.