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Objective: This study aimed to investigate the association between alcohol consumption and the prevalence of stroke in Chinese adults aged 40 years and over., Method: We conducted a cross-sectional analysis among 113,573 Chinese adults aged ≥ 40 years in the China National Stroke Prevention Project (2014-2015) to examine correlations of alcohol consumption with the prevalence of stroke. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), controlling for various confounders, e.g., gender, age, smoking, physical activity and other health conditions., Results: Within the study population, a total of 12,753 stroke survivors were identified. The prevalence of light to moderate and of heavy alcohol consumption was 10.1% and 5.7% respectively. The multivariate logistic regression results show that light to moderate alcohol consumption was associated with reduced risk of stroke of all types [0.91 (95%CI: 0.85-0.97)] and of ischemic stroke [0.90 (0.84-0.97)]. No association was found between alcohol consumption and hemorrhagic stroke. Compared with abstainers, the adjusted ORs of all stroke were 0.83 (0.75-0.92) for those who drank 11-20 years, and no association was found between 1 and 10 years or over 20 years of drinking and risk of stroke., Conclusions: These results indicate that light to moderate alcohol consumption may be protective against all and ischemic stroke, and heavy drinking was not significantly associated with risk of all stroke in China. No association between alcohol consumption and hemorrhagic stroke was found., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Aims: We aim to find out the factors affecting the use of anticoagulants and the intensity of their choices, and to establish a basis for improving neurologists' effective implementation of the guidelines., Methods: A cross-sectional study is conducted in Hubei province in central China. Each neurologist completes a standard-structured anonymous questionnaire through face-to-face interviews. The problems include the attitude and options about anticoagulant therapy., Results: A total of 611 neurologists from 38 hospitals respond to this survey. For the best treatment of atrial fibrillation, more than 80% of physicians choose anticoagulant therapy. For patients with atrial fibrillation and cerebral infarction, physicians think that Warfarin is the preferred drug as high as 93.8%. Among the anticoagulant drugs ever used by clinicians, the use rate of Warfarin is 93.8%, but the use rate of direct oral anticoagulants is insufficient. The use of direct oral anticoagulants is related to the educational level and the geographical location of the hospital. Bleeding risk is the first reason influencing clinicians' choice of Warfarin, accounts for 88.9%. 97.7% of the clinicians recommend patients with Warfarin to regularly monitor the INR, but the frequency of monitoring is inconsistent. Clinicians have a high willingness to learn about AF, but the proportion of hospitals that carry out appropriate training is low., Conclusions: There are still some gaps with the guidelines on the choice of anticoagulant drugs. Neurologists have positive attitude towards anticoagulant therapy and a strong willingness to learn, but the corresponding training is lacking. Continuous professional training is necessary., (© 2021 John Wiley & Sons Ltd.)

Background: Physicians' knowledge and practice of atrial fibrillation (AF) are determinants of the efficacy of thromboprophylaxis., Hypothesis: This study aimed to investigate physicians' knowledge, attitude, and practice toward AF, to analyze the influencing factors, and to provide data to support departments that develop health policies., Methods: A cross-sectional study was carried out from October 1, 2016, to March 31, 2018. A standard-structured anonymous questionnaire was completed by each participant through face-to-face interviews., Results: A total of 611 doctors from 38 hospitals were responded to this survey. The mean of the total score of the questionnaire was 21.59 ± 3.559 (total score of the questionnaire was 36), and the mean scores of knowledge, attitude, and practice were 6.86 ± 1.70, 6.13 ± 1.35, and 8.59 ± 2.21, respectively. The doctor' s knowledge, practice scores, and total scores were positively correlated with the education level and the workplace. The influencing factors that affect doctors' knowledge, attitudes, and practice scores including education level, professional title, working years, hospital grade, and hospital location., Conclusions: There was still a big gap in neurologists' knowledge and practice about AF. It is necessary to strengthen the continuous improvement of doctor training to improve the management of AF., (© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)

Background: Dyslipidemia is a modifiable risk factor for cardiovascular disease (CVD). We investigated the prevalence and associated risk factors of dyslipidemia- raised total cholesterol (TC), raised triglycerides (TG), raised low-density lipoprotein (LDL-C), low high-density lipoprotein (HDL-C), and raised non-high-density lipoprotein (non-HDL-C) in rural and urban China., Methods: We analyzed data from 136,945 participants aged 40-100 years of the CNSSPP project for 2014. Dyslipidemia was defined by the NCEP-ATP III and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Complete data on demographic, metabolic and lifestyle characteristics were used. Chi-square tests and multivariable logistic regression were used to obtain age- and sex-adjusted prevalence and risk factors for dyslipidemia among participants., Results: A total of 53.1% participants lived in rural areas. The prevalence of dyslipidemia was similar among rural and urban participants (43.2% vs. 43.3%). Regarding the components of dyslipidemia: urban compared with rural participants had a higher prevalence of low HDL-C (20.8% vs. 19.2%), whereas the prevalence of raised LDL-C (7.8% vs. 8.3%), raised TC (10.9% vs.11.8%) and raised non-HDL-C (10.0% vs. 10.9%) were lower in urban residents, (all p < 0.001). Women were more likely to have raised TC than men (adjusted OR [AOR] =1.83, 95% confidence interval [CI]:1.75-1.91), raised LDL-C (AOR = 1.55, 95% CI: 1.47-1.63) and high non-HDL-C (AOR = 1.52 95% CI: 1.45-1.59) (all p < 0.001). Compared with rural, urban participants had higher odds of dyslipidemia: low HDL-C (AOR = 1.04, 95% CI: 1.01-1.07), and raised TG (AOR = 1.06, 95% CI: 1.04-1.09). Hypertension and current drinker were less likely to get low HDL-C with AOR 0.93 (95% CI: 0.90-0.96) and AOR 0.73 (95% CI: 0.70-75), respectively. Overweight, obesity, central obesity and diabetes had higher odds of all dyslipidemias (p < 0.001)., Conclusions: Low HDL-C was higher in urban areas, whereas the remaining dyslipidemia types were more common in rural areas. Dyslipidemia was more common in women in both areas of residence. Overweight, obesity, central obesity and diabetes were associated with dyslipidemias. The need to intensify intervention programs to manage dyslipidemia and risk factors should be prioritized.

Background: Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists' experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists., Methods: Survey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists' experiences with thrombolysis., Results: Of the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR] = 5.81, 95% confidence intervals [CI] 3.31-10.20), using emergency medical services to be hospitalized (OR = 3.36, 95% CI 2.00-5.62), stroke history (OR = 0.53, 95% CI 0.28-0.99), and National Institute of Health Stroke Scale score < 4 (OR = 0.46, 95% CI 0.27-0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR = 2.84, 95% CI 1.84-4.37), education level (OR = 2.49, 95% CI 1.09-5.73), and working years (OR = 1.88, 95% CI 1.18-3.00) were strongly associated with neurologists' experiences of thrombolysis., Conclusions: A very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. This study aimed to estimate the prevalence of AF in different socioeconomic regions of China and identify its association with stroke, through a national survey., Methods: The study included 726,451 adults aged ≥40 years who were participants of the China National Stroke Screening and Prevention Project, a nationally representative cross-sectional study. Stepwise logistic regression analyses were conducted to investigate the association between AF and stroke., Results: The overall standardized prevalence rate of AF was 2.31%. The prevalence of AF was highest in high-income regions (2.54%), followed by middle-income regions (2.33%), and lowest in low-income regions (1.98%). Women had a higher prevalence of AF than men in all regions (low-income regions, 2.30% vs 1.65%; middle-income regions, 2.78% vs 1.89%; and high-income regions, 2.96% vs 2.12%). Compared with urban residents, the prevalence of AF among rural residents was higher in low- (2.03% vs 1.91%) and middle-income regions (2.69% vs 1.90%), but lower in high-income regions (2.44% vs 2.58%). Participants with AF were more likely to have a stroke than those without AF (9.48% vs 2.26%). After adjusting for age, sex, location, overweight or obese, smoking, drinking, physical inactivity, hypertension, diabetes, dyslipidemia, and a family history of stroke, results showed that AF was significantly associated with stroke., Conclusions: The prevalence of AF has increased in recent years, and it was positively correlated with socioeconomic status, sex (women), location (rural areas), and stroke., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Although the impacts of smoking on health are well established, it is unclear on how they affect the Chinese population aged ≥40 years. This study aimed to investigate the association between smoking and risk of stroke in middle-aged and older Chinese adults, based on the data from the China National Stroke Prevention Project.A community-based cross-sectional study with 12,704 (5681 men, 7023 women) Chinese adults aged ≥40 years was conducted to examine the association of smoking with stroke. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Among the study population, a total of 524 stroke survivors were identified. The age-adjusted prevalence of stroke was 4.06% for both sexes, 2.95% for women, and 5.38% for men. The multivariate-adjusted ORs (95% CI) of stroke associated with current cigarette smoking and former cigarette smoking were 1.67 (1.24-2.25) and 1.93 (1.29-2.87), respectively. Compared with those who were never-smokers, the multivariate-adjusted OR of stroke (95% CI) were 1.48 (0.96 to -2.29), 1.75 (1.20-2.56), and 2.37 (1.20 to -4.68) for those who smoked 1 to 10, 11 to 20, and ≥21 cigarettes per day; and 0.51 (0.19 to -1.42), 1.90 (1.36 to -2.67), and 2.01 (1.17 to -3.46) for those who smoked 1 to 19, 20 to 39, and ≥40 years, respectively (both P < .001 for linear trends). Among former smokers, the multivariable-adjusted ORs of stroke by duration of smoking cessation (compared with never smokers) for <5, 5 to 19, and ≥20 years were 3.47 (1.42-8.49), 3.37 (1.95-5.80), and 0.95 (0.49-1.84), respectively (P = .009 for linear trend). The increased odds of stroke with smoking were more evident among participants who were men, >60 years old, or without family history of stroke than their counterparts.This study suggests the increased odds of stroke in current cigarette smokers with a graded increase in prevalent risk that depended on how many cigarettes and how many years were smoked. Moreover, quitting smoking appears to decrease this excess risk substantially.

Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.

Background: Numerous studies have suggested the relationship between sleep duration and risks of stroke mortality and morbidity, however, the effect estimates varied substantially across studies and it remains unknown how many hours of habitual sleep are associated with the lowest risk of stroke outcomes. Therefore, we performed a dose-response meta-analysis of prospective cohort studies to evaluate the relation of sleep duration with risk of total mortality and stroke events., Methods: PubMed and Embase databases were searched through January 2016, and multivariate-adjusted relative risks were pooled by using fixed-effects models. Semiparametric and dose-response methods were used to assess the relationship of sleep duration and risk of stroke and stroke mortality., Results: Eleven articles with 16 independent reports were included in our meta-analysis. An approximate J-shaped relationship was detected between sleep duration and risk of stroke and stroke mortality. No evidence of a curve linear relationship was seen between sleep duration and risk of stroke or stroke mortality. Compared with 7-h sleep duration per day, the pooled relative risks for stroke events were 1.07 (95% CI 1.02-1.12) for each 1-h shorter sleep duration among individuals who slept <7h per day and 1.17 (1.14-1.20) for each 1-h increase of sleep duration among individuals with longer sleep duration and the pooled RR for stroke mortality was 1.17 (95% CI 1.13-1.20) per 1-h increase of sleep duration., Conclusions: Both short and long duration of sleep are predictors of stroke outcomes, and long sleep duration is significant marker of stroke mortality., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background and Purpose: Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China., Methods: A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization., Results: Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used., Conclusions: A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke., (© 2016 American Heart Association, Inc.)

Objective: Genome-wide single nucleotide polymorphism (SNP) association studies recently identified two SNPs (rs11833579 and rs12425791) on chromosome 12p13 that are associated with ischemic stroke (IS) in Caucasian or Black persons from America and the Netherlands. Our aim was to determine whether these SNPs were associated with IS in Chinese Han population., Methods: We used a case-control study involving 648 IS patients and 648 age-matched, sex-matched, and ethnicity-matched non-IS controls from two ethnic populations and determined the genotypes of two polymorphisms by TaqMan SNP genotyping assays to assess any links with IS., Results: Significant allelic association was identified between rs11833579 and IS in the Han population (odds ratio=1.27, 95% confidence interval=1.08-1.49). One risk haplotype (A-G; odds ratio=1.52, 95% confidence interval=1.21-1.92) was identified in the Han population. Genotypic association analysis demonstrated that rs11833579 confers susceptibility to IS only in a recessive model (P=0.004) rather in additive model. However, the association between rs12425791 and IS was insignificant in Chinese Han population., Conclusion: The A allele of SNP rs11833579 on chromosome 12p13 may play a role in mediating susceptibility to IS in the Han Chinese population in a recessive model. The A-G haplotype is also significantly associated with higher IS risk in the Han Chinese population. However, larger populations are warranted to validate our findings.

Background: Increasing evidences for the role of tumor necrosis factor-alpha (TNF-alpha) in the occurrence of ischemic stroke (IS) have shown that it belongs to pro-inflammatory cytokines and carries functional polymorphisms (TNF-alpha -238G/A and TNF-alpha -308G/A) in its promoter region, which affect their transcription rate and plasma cytokine level. We determined the association between these polymorphisms and the occurrence of IS in the Chinese Han and Uyghur populations., Methods: The TNF-alpha -238G/A and TNF-alpha -308G/A polymorphisms were determined by TaqMan SNP Genotyping assays in cases (n=748) and controls (n=748). Multivariate logistic regression analysis was used to show the association between the TNF-alpha genotypes and the IS events., Results: No significant difference was found in the association between TNF-alpha -238G/A and IS in both ethnic populations. The result showed that carriage of the TNF-alpha -308GA was a decreased risk of IS in both Han and Uyghur populations (OR:0.453, 0.213). In addition, the significant difference in GA frequency in TNF-alpha was found between the two ethnic controls (P=0.000)., Conclusions: TNF-alpha -308 GA heterozygous may be an independent protective factor for IS in the Chinese Han and Uyghur populations., (Copyright 2010 Elsevier B.V. All rights reserved.)

Polymorphisms of G-572C and G-174C in the interleukin-6 (IL-6) promoter can affect both the transcription and secretion of IL-6 and may be involved in inflammation related to and the pathogenesis of ischemic stroke (IS). However, whether IL-6 polymorphisms are indeed risk factors for IS remains controversial. We recruited 748 Chinese IS patients diagnosed by magnetic resonance imaging (MRI) within 24h of symptom onset and 748 normal healthy controls from two ethnic populations and performed two case-control studies in order to assess the nature of the polymorphisms of IL-6 and any links with IS. Common polymorphic loci in the IL-6 gene promoter were determined by TaqMan SNP genotyping assays. Multivariate logistic regression analysis was used to examine the association between IL-6 genotypes and a diagnosis of IS. We found that the C allele frequency at the -174 promoter region of IL-6 was extremely low in both IS patients and controls in both ethnic groups. The G allele of the promoter single nucleotide polymorphism (SNP) G-572C was more common in IS subjects than controls (P=0.004, corrected for multiple testing) in the Han population but not in the Uyghur population. GC carriage therefore increased the risk of IS in the Han ethnic group (OR 1.45, 95% CI 1.13-1.86). In addition, the differences in GG and GC frequency between the two ethnic populations were significant. The C allele frequency at the -174 promoter region of IL-6 was rare in Chinese IS patients and controls from either ethnic group. We conclude that IL-6-572GC may be an independent risk factor for IS in the Chinese Han population., (Copyright 2009 Elsevier Inc. All rights reserved.)

Background: The metabolic syndrome (MetS) is related with cardiovascular disease. However, its relationship with diabetes mellitus (DM) has not been examined in Chinese population with a larger sample. We aimed to assess the relationship between metabolic syndrome (MetS) and its components, and DM, and to determine the best one from the available definitions of Mets when assessing the risk of DM.Methods: This was a cross-sectional survey in a nationally representative sample of 109,551 Chinese adults aged ≥40 years in 2014-15. MetS was defined according to three criteria including the updated International Diabetes Federation (IDF) criterion, the National Cholesterol Education Program Third Adult Treatment Panel (NCEP ATP III) criterion and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criterion. Logistic regression models were used to estimate the odds of DM.Results: MetS as defined by three criteria including IDF, NCEP ATP III,and AHA/NHLBI all increased the prevalence of DM, and the adjusted ORs with 95% CI was more higher using NCEP ATP III (3.65, 3.52-3.79) than IDF (2.50, 2.41-2.60) and AHA/NHLBI (3.03, 2.92-3.24). The odds of DM was highest in hyperglycemia with cut-off glucose≥6.1 mmol/L (14.55, 13.97-15.16), and other components were also associated significantly with DM. There was heterogeneity for OR of DM associated with various trait combinations.Conclusions: The NCEP ATPIII MetS definition may be more suitable for assessment of DM risk in Chinese population. Hyperglycemia, as previous study reported, are important risk factors of DM. Besides, other traits of Mets are also significantly associated with DM and should therefore be of greater concern. [ABSTRACT FROM AUTHOR]

Abstract: Endothelial nitric oxide synthase (eNOS) plays an important role in mediating endothelium-dependent vasodilatation and antithrombotic action and is thus involved in the development of ischemic stroke (IS). Controversial results regarding the association of eNOS gene variable number of tandem repeats (VNTR) polymorphism with IS have been reported by conventional PCR-polyacrylamide gel electrophoresis methods. We aimed to identify any common association of eNOS gene VNTR polymorphism with IS in Chinese Han population by capillary electrophoresis (CE). The VNTR polymorphism of 27bp within the eNOS intron-4 was determined by CE with specially designed tailed primers in Chinese Han patients with IS (n=457) and matched elderly controls without IS (n=457). Significant differences in BMI, WHR, hypertension, diabetes, smoking, TG, HDL, LDL, LDL, and FBG were observed between cases and controls. The distributions of eNOS VNTR polymorphism were not significantly associated with IS after adjustment for cardiovascular risk factors (OR=1.18, 95% CI: 0.82–1.69). This finding was consistent with the further meta-analysis in Asians. The meta-analysis in Americans demonstrated that 4a/4b+4a/4a genotype was significantly associated with IS risk with an OR of 1.54 (95% CI, 1.09–2.17) compared with the 4b/4b genotype. Our data suggests that BMI, WHR, hypertension, diabetes, smoking, TG, LDL, and FBG may increase the risk of IS. However, eNOS VNTR polymorphism may be not an independent major contributor for IS in Chinese Han population. The VNTR polymorphism might be associated with IS in Americans based on meta-analysis. [Copyright &y& Elsevier]

Abstract: Recent genome-wide association studies (GWAS) have identified two key SNPs (rs11833579 and rs12425791) on chromosome 12p13 that were significantly associated with stroke in Caucasians. However, the validity of the association has remained controversial. We performed genetic association analyses in a very unique population which has 60% European ancestry and 40% East Asian ancestry. No significant association between these two SNPs and ischemic stroke was detected in this Chinese Uyghur population. [Copyright &y& Elsevier]