Awareness of Risk Factors for Cerebrovascular Diseases among Acute Ischemic Stroke Patients in Shenzhen, China

Research Article

J Cardiovasc Disord. 2023; 9(1): 1052.

Awareness of Risk Factors for Cerebrovascular Diseases among Acute Ischemic Stroke Patients in Shenzhen, China

Shiyu Hu; Zhihao Lei; Yang Wang*; Lijie Ren*

Neurology department of Shenzhen Seocnd People’s Hospital/ First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China

*Corresponding author: Lijie Ren, & Yang WangNeurology department of Shenzhen Seocnd People’s Hospital/ First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China Email: 13631605966@126.com; helenwy1978@163.com

Received: September 15, 2023 Accepted:October 13, 2023 Published: October 20, 2023

Abstract

Background and Purpose: Unawareness of the risk factors is one of the most important issues need to be settled for the stroke prevention. We aimed to evaluate the awareness of risk factors for Cerebrovascular Diseases (CVDs) among acute ischemic stroke patients, and to investigate the characteristics of patients who were unaware of their risk factors in Shenzhen, China.

Methods: Registered data on awareness of CVDs risk factors of patients with confirmed Acute Ischemic Stroke (AIS) from June 2019 to December 2020 were analyzed in May 2021. The data were extracted from the database of Shenzhen Quality Control Center for Management of Cerebrovascular Diseases.

Results: Totally, there were 5147 AIS patients with complete data eligible for this study. AIS patients’ awareness regarding existing hypertension, diabetes, dyslipidemia and Atrial Fibrillation (AF) was 76.1%, 76.2%, 24.2% and 53.4% respectively. Patients who were lack of awareness of the CVDs risk factors were more likely to be males, individuals with younger age and without medical insurance or CVDs history.

Conclusions: The overall awareness of the CVDs risk factors was suboptimal among AIS patients in Shenzhen, especially for the existing dyslipidemia. Age was an independent factor associated with the lack of awareness of the CVDs risk factors. The stroke screening program should be extending to younger people.

Introduction

Stroke is a leading cause of disability worldwide and the leading cause of death in China [1,2]. Although stroke mortality have decreased in the past decade, the number of stroke survivors as well as the overall global stroke burden are still increasing [3]. China is predicted to to have the highest estimated lifetime risk of stroke up to 39.3%, which would impose an enormous disease burden [4]. Moreover, the burden of stroke is aslo huge in younger people and the incidence of stroke is still increasing in young people [5]. Shenzhen is an economically developed city in South China with median age of 31.95, but with ischemic stroke incidence up to 102 cases per 100000 person-years [6,7].

Tracking and controlling of the modifiable stroke risk factors, such as hypertension, diabetes and dyslipidaemia, are critical in stroke prevention and management. However, the prevalence of hypertension, smoking, diabetes as well as other modifiable risk factors were still high in stroke survivors based on China Stroke Statistics 2019 [8]. The prevalence of those risk factors were even higher in Shenzhen compared with the average status of China [9]. Previous studies indicated the awareness of Cerebrovascular Diseases (CVDs) risk factors was lower in China than Western countries [10,11]. Therefore, we suppose that the unawareness of the risk factors is one of the most important issues need to be settled for the stroke management and prevention. But the awareness condition of CVDs risk factors is still unclear among stroke patients in Shenzhen, China. In this study, we aimed to assess the awareness of risk factors for CVDs among Acute Ischemic Stroke (AIS) patients in Shenzhen, China. In addition, investigation of the characteristics of patients who were not aware of their risk factors to improve stroke management and prevention strategies.

Methods

The Shenzhen Quality Control Center for Management of Cerebrovascular Diseases was established since 2014. By the end of 2020, there were overall 29 hospitals covers the whole city registered patients admission to hospitals with acute cerebrovascular diseases annually. All patients or their guardians were informed consent to participate in this medical quality control program. Meanwhile, the data was public for application and de-identified. We retrospectively collected the registered clinical information of patients with acute ischemic stroke from June 2019 to December 2020. All data were analyzed in May 2021. The eligibility of each stroke case was confirmed by brain Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) during hospitalization. The glucose and lipids metabolism were assessed by the fasting biochemical profiles on the second morning after admission.

Data Collection and Definition of Variables

The demographic characteristics, including age, gender, smoking status, medical insurance condition, Body Mass Index (BMI) as well as self-reported history of stroke, Myocardial Infarction (MI) and Transient Ischemic Attack (TIA), were extracted from the database. We evaluated the patients’ awareness of hypertension, dyslipidemia, diabetes and Atrial Fibrillation (AF) by comparison their past medical history and clinical assessment during hospitalization. Individuals were assessed as unawareness of hypertension if their admission mean (measured three times) Systolic Blood Pressure (SBP) =140mmHg or mean Diastolic Blood Pressure (DBP) =90mmHg [12] but without self reported hypertension history or taking antihypertensive agents before admission. Diabetes were diagnosed as serum fasting blood glucose level higher than 7.0mmol/l, or postprandial blood glucose higher than 11.1mmol/L with diabetic related symptoms [13]. Patients met with the diagnostic criteria but did not reported diabetes history or taking hypoglycemic agents were assessed as unawareness of diabetes. Patients with serum Lower Density Lipids (LDL) level higher than 130 mg/dl (3.4mmol/l) [14] but without self reported dyslipidemia history or taking lipid lowering agents before admission were evaluated as unawareness of dyslipidemia. Unawareness of AF was defined as electrocardiograph confirmed paroxysma or persistent AF but lack of self reported AF history at admission.

Statistical Analysis

We presented continuous variables by Mean±Standard deviation or medians [Interquartile Range (IQR)] based on whether data was normally distributed. Categorical variables were presented by frequencies. Differences between aware and unaware groups were compared by means of the Kruskal-Wallis nonparametric test for non-normal distributed continuous variables, and t-tests for normal distributed continuous variables. Pearson’s Chi squared test was used for the comparison of categorical variables. The association of variables associated with CVDs risk factors awareness was assessed in univariate logistic regression analyses and a full multivariable model, including predictors simultaneously. p values less than 0.05 were classed as significant in all analyses Statistical analysis was performed using SPSS software, version 22.0 (SPSS IBM Inc, Chicago, IL, USA).

Results

Awareness of Hypertension

Overall, we collected 5147 acute ischemic stroke patients in this retrospective study (Figure 1). There were 4369 (84.9%) patients diagnosed as hypertension, among which 3129 (71.6%) patients knew the existence of disease. The rate of taking antihypertensive medicines was about 61.6% among patients with awareness of their hypertension. Patients unaware of their hypertensive status were younger (61.80 vs 58.36, p<0.001) and male-dominated (69.7% vs 76.3%, p<0.001). Patients had medical insurance (p=0.001) and illness history of stroke (p<0.001) or MI (p=0.046) might have better awareness of hypertension. There were more smokers actually quit smoking (12.5% vs 7.8%, p<0.001) and less current smokers (24.3% vs 31.1%, p<0.001) among patients aware of hypertension. The LDL levels (2.93 vs 3.04mmol/l, p<0.001) and DBP (91 vs 93mmHg, p=0.001) were slightly higher in patients showed unawareness of hypertension, while the glucose (FBG, 5.82 vs 5.63mmol/l, p<0.001; HbA1C, 6.64% vs 6.46%, p=0.004) and uric acid (UA, 353 vs 344umol/l, p=0.019) levels were higher in patients known their blood pressure issues (details shown in Table 1).