scholarly journals Development and internal validation of a multivariable prediction model for 6-year risk of stroke: a cohort study in middle-aged and elderly Chinese population

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e048734
Author(s):  
Qi Yu ◽  
Yuanzhe Wu ◽  
Qingdong Jin ◽  
Yanqing Chen ◽  
Qingying Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prediction Model ◽  
Ischaemic Stroke ◽  
Chinese Population ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Haemorrhagic Stroke ◽  
Middle Aged ◽  
Elderly Chinese ◽  
Risk Predictors

ObjectiveTo develop and internally validate a prediction model for 6-year risk of stroke and its primary subtypes in middle-aged and elderly Chinese population.DesignThis is a retrospective cohort study from a prospectively collected database.ParticipantsWe included a total 3124 adults aged 45–80 years, free of stroke or myocardial infarction at baseline in the 2009–2015 cohort of China Health and Nutrition Survey.Primary and secondary outcome measuresThe outcome of the prediction model was stroke. Investigated predictors were: age, gender, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), hypertension (HBP), drinking status, smoking status, diabetes and site. Stepwise multiple Cox regression was applied to identify independent predictors. A nomogram was constructed to predict 6-year risk of stroke based on the multiple analysis results. Bootstraps with 1000 resamples were applied to both C-index and calibration curve.ResultThe overall incidence of overall stroke was 2.98%. Age, gender, HBP and TC were found as significant risk predictors for overall stroke; age, gender, HBP and LDL-C were found as significant risk predictors for ischaemic stroke; age, gender, HBP, BMI and HDL-C were found as significant risk predictors for haemorrhagic stroke. The nomogram was constructed using significant variables included in the model, with a C-index of 0.74 (95% CI: 0.72 to 0.76), 0.74 (95% CI: 0.71 to 0.77), and 0.81 (95% CI: 0.78 to 0.84) for overall stroke, ischaemic stroke, and haemorrhagic stroke model, respectively. The calibration curves demonstrated the good agreements between predicted and observed 6-year risk probability.ConclusionOur nomogram could be convenient, easy to use and effective prognoses for predicting 6-year risk of stroke in middle-aged and elderly Chinese population.

scholarly journals Edoxaban versus warfarin on stroke risk in patients with atrial fibrillation: a territory-wide cohort study

2021 ◽  
Author(s):  
Dicken Kong ◽  
Jiandong Zhou ◽  
Sharen Lee ◽  
Keith Sai Kit Leung ◽  
Tong Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Lower Risk ◽  
Cox Regression ◽  
Significant Risk ◽  
Risk Predictors

AbstractBackgroundIn this territory-wide, observational, propensity score-matched cohort study, we evaluate the development of transient ischaemic attack and ischaemic stroke (TIA/Ischaemic stroke) in patients with AF treated with edoxaban or warfarin.MethodsThis was an observational, territory-wide cohort study of patients between January 1st, 2016 and December 31st, 2019, in Hong Kong. The inclusion were patients with i) atrial fibrillation, and ii) edoxaban or warfarin prescription. 1:2 propensity score matching was performed between edoxaban and warfarin users. Univariate Cox regression identifies significant risk predictors of the primary, secondary and safety outcomes. Hazard ratios (HRs) with corresponding 95% confidence interval [CI] and p values were reported.ResultsThis cohort included 3464 patients (54.18% males, median baseline age: 72 years old, IQR: 63-80, max: 100 years old), 664 (19.17%) with edoxaban use and 2800 (80.83%) with warfarin use. After a median follow-up of 606 days (IQR: 306-1044, max: 1520 days), 91(incidence rate: 2.62%) developed TIA/ischaemic stroke: 1.51% (10/664) in the edoxaban group and 2.89% (81/2800) in the warfarin group. Edoxaban was associated with a lower risk of TIA or ischemic stroke when compared to warfarin.ConclusionsEdoxaban use was associated with a lower risk of TIA or ischemic stroke after propensity score matching for demographics, comorbidities and medication use.

scholarly journals Triglycerides to High-Density Lipoprotein Cholesterol Ratio Is the Best Surrogate Marker for Insulin Resistance in Nonobese Middle-Aged and Elderly Population: A Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yumei Yang ◽  
Baomin Wang ◽  
Haoyue Yuan ◽  
Xiaomu Li
Keyword(s):  
Insulin Resistance ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Chinese Population ◽  
Density Lipoprotein ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Middle Aged ◽  
Cross Sectional ◽  
Elderly Chinese

Objective. Insulin resistance (IR) is closely associated with metabolic profiles, including obesity and dyslipidemia. The aim of the present study was to examine how lipid profiles were associated with IR in nonobese middle-aged and elderly Chinese population. Methods. This cross-sectional study included 1608 subjects. IR was defined by homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5. Results. In nonobese subjects (body mass index (BMI) < 25 kg/m2, n = 996), triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (odds ratio (OR) = 1.43, 95% confidence interval (CI) 1.13–1.81, P = 0.003 ) was an independent risk factor for IR. The best marker for predicting IR in nonobese subjects was TG/HDL-C ratio with the areas under the receiver operating characteristic curves (AUC) of 0.73 ( P < 0.001 ). The optimal cut-off point to identifying IR for TG/HDL-C ratio was ≥1.50 in the nonobese population. Other markers like BMI, TG, and total cholesterol (TC)/HDL-C also had acceptable discriminatory power for predicting IR in nonobese population (AUC ≥ 0.7 and P < 0.001 ). BMI had the highest AUC of 0.647 ( P < 0.001 ) after being adjusted, but it was not effective enough to predict IR in obese subjects (BMI ≥ 25.0, n = 612). Conclusions. The TG/HDL-C ratio may be the best reliable marker for predicting IR in the nonobese middle-aged and elderly Chinese population.

Discordance Between Apolipoprotein B or Non-HDL-Cholesterol and LDL-Cholesterol in Middle-aged and Elderly Chinese Patients Predicts Arterial Stiffness

2021 ◽  
Author(s):  
Geyue Qu ◽  
Zhongying Zhang ◽  
Hong Zhu
Keyword(s):  
Arterial Stiffness ◽  
Apolipoprotein B ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipoprotein Cholesterol ◽  
Chinese Patients ◽  
Middle Aged ◽  
Residual Cardiovascular Risk ◽  
Elderly Chinese ◽  
The Mean

Abstract Background: Discordance of lipid parameters is closely associated with residual cardiovascular risk. This study investigated the discordance between non-high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB), and low-density lipoprotein cholesterol (LDL-C) and assessed arterial stiffness risk.Methods: This study included a total of 402 middle-aged and elderly Northern Chinese individuals, whose brachial-ankle pulse wave conduction velocity(baPWV), as well as clinical and biochemical data, were measured. Arterial stiffness was defined as the upper quartile of the baPWV. All participants were divided into four mutually exclusive concordance/discordance groups based on the lipid goal for very high-risk populations, according to the 2016 European Society of Cardiology / European Atherosclerosis Society guidelines. Discordance was defined as an LDL-C≥ 1.81mmol/L with non-HDL-C< 2.59mmol/L, or apoB <0.80mmol/L, or vice versa.Results: The mean age of the participants was 65.9±13.0 years, and 59.5% were male. The mean LDL-C was 2.41±0.81mmol/L, non-HDL-C 3.06±0.94mmol/L, and apoB 0.84±0.21mmol/L. LDL-C was observed to be discordant with non-HDL-C (20.1%) and apoB (30.8%). When stratified according to LDL-C levels, the baPWV was greater in those patients with higher non-HDL-C or apoB levels. The Spearman analysis showed a significant association between discordant lipid patterns and the presence of arterial stiffness(r= 0.131 and r=0.117, respectively). In the adjusted logistic regression model, low LDL-C and high non-HDL-C or apoB discordance were also associated with the risk of arterial stiffness (OR: 13.412 and OR: 13.054, respectively).Conclusions: There was discordance between the LDL-C and non-HDL-C, or apoB in middle-aged and elderly Chinese individuals, which was associated with a higher risk of arterial stiffness. The non-HDL-C or apoB levels could be used to identify individuals who could benefit from more intensive lipid modification.

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