Association of Blood Pressure With Stroke Risk in Chinese Population: A 6-Year Prospective Cohort Study

2021 ◽  
Author(s):  
Qi Yu ◽  
Qing-Dong Jin ◽  
Yan-Qing Chen ◽  
Xin-Ru Liu ◽  
Qing-Ying Lin
Keyword(s):  
Blood Pressure ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Positive Association ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Nutrition Survey ◽  
Cox Models ◽  
Nonlinear Relationships

Abstract Objective: Previous results on the association between blood pressure(BP) and stroke risk were controversial. We investigated the association of BP with stroke risk in China. Method: We included a total of 5,700 adults aged 40-90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP and stroke. Result: With a median follow-up of 6 years, a total of 5,700 individuals were enrolled in our study, of whom 178 developed stroke. Multivariable adjusted Cox models including systolic blood pressure(SBP) and diastolic blood pressure(DBP) showed a strong positive association between SBP and overall stroke. Compared with participants with SBP 0-130 mmHg, the multivariable adjusted HRs[95% CIs] in participants with SBP 130-140, 140-160, 160-180, and ≥180 mmHg were 1.08[0.62-1.89], 2.41[1.51-3.86], 2.21[1.16-4.20], and 3.90[1.78-8.55] for overall stroke; 0.65[0.21-2.04], 3.68[1.73-7.83], 2.51[0.84-7.47], and 5.91[1.69-20.60] for ischemic stroke; 1.26[0.50-3.20], 1.19[0.47-3.04], 2.06[0.66-6.41], and 5.10[1.36-19.20] for hemorrhagic stroke. Restricted cubic spline analyses including SBP and DBP showed linear relationships of SBP with overall, ischemic and hemorrhagic stroke. No linear or nonlinear relationships of DBP with overall, ischemic and hemorrhagic stroke were observed.Conclusion: SBP is independently and directly related to the risk of overall and its subtypes. Besides, the risk of ischemic and hemorrhagic stroke might be higher when SBP were more than 140 mmHg and 160 mmHg.

scholarly journals Effect of Blood Pressure on Cardiovascular Outcomes: A 15-Year Prospective Cohort Study

2021 ◽  
Author(s):  
Qi Yu ◽  
Qing-Dong Jin
Keyword(s):  
Blood Pressure ◽  
Proportional Hazards ◽  
Positive Association ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Composite Outcome ◽  
Nutrition Survey ◽  
Cox Models ◽  
Diabetes Status

Abstract Objective The association between blood pressure(BP) and cardiovascular outcomes has not been well investigated by large prospective studies on Chinese. We aim to analyze the association of BP with cardiovascular outcomes in Chinese population. Method We included a total of 4,569 adults aged 40–90 years from the China Health and Nutrition Survey (CHNS) cohort. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs. Restricted cubic spline analyses were used to explore linear and nonlinear relationships of BP with cardiovascular outcomes. Result With a mean follow-up of 12.1 years, a total of 4,569 individuals were enrolled in our study, of whom 403 developed cardiovascular outcomes. Multivariable adjusted Cox models showed a strong positive association between BP and cardiovascular outcomes. SBP was significantly associated with composite outcome(HR per 10 mmHg 1.23[1.16–1.29]), myocardial infarction(MI)(HR per 10 mmHg 1.17[1.07–1.27]), and stroke(HR per 10 mmHg 1.29[1.21–1.38]). DBP was significantly associated with composite outcome(HR per 10 mmHg 1.32[1.20–1.44]), MI(HR per 10 mmHg 1.26[1.10–1.44]), and stroke(HR per 10 mmHg 1.39[1.25–1.55]). Restricted cubic spline analyses showed linear relationships of either SBP or DBP with composite outcome, MI and stroke. Conclusion Either SBP or DBP is independently and linearly related to the risk of cardiovascular outcomes. These associations are steeper for stroke than for MI, and vary widely by age, use of antihypertensive treatment, and diabetes status.

scholarly journals Markers of Iron Metabolism and Stroke Risk: Cross-Sectional and Longitudinal Findings from the China Health and Nutrition Survey (CHNS)

2022 ◽  
Author(s):  
Dong Liu ◽  
Ya Zhang ◽  
Cui-Cui Wang ◽  
Xiao-Hong E ◽  
Hui Zuo
Keyword(s):  
Iron Metabolism ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
High Sensitivity ◽  
Cox Proportional Hazards ◽  
Contributing Factors ◽  
Nutrition Survey ◽  
Cross Sectional ◽  
Health And Nutrition ◽  
Cox Proportional Hazards Models

Background: The association of iron metabolism or status with the stroke risk remains unclear. We aimed to examine the associations between markers of iron metabolism or status and stroke risk using data from the China Health and Nutrition Survey (CHNS). Methods: Overall, 8589 in the CHNS in 2009, and 7290 participants between 2009 and 2015 were included in the cross-sectional and longitudinal analyses, respectively. Markers included hemoglobin, ferritin (FET), transferrin (TRF), soluble transferrin receptor (sTRF-R), and ratio of sTRF-R/log FET (sTfR-F index). Multivariable logistic regression and Cox proportional hazards models were used to analyze the associations between those markers and risk of stroke. Age, gender, high-sensitivity CRP (hsCRP), body mass index (BMI), current smoking, drinking status, diabetes and hypertension were included as potential confounding factors. Results: We observed longitudinal associations of hemoglobin (HR: 1.54, 95% CI: 1.15 – 2.06, P = 0.004), and sTfR-F index (HR: 0.68, 95% CI: 0.46 – 0.99, P = 0.044) with stroke risk among the participants whose BMI ≤ 23 kg/m2. In addition, FET levels were significantly associated with stroke risk among female (HR: 1.45, 95% CI: 1.00 – 2.09, P = 0.049) after a median of 6.1 years follow-up. Hemoglobin, FET, TRF, sTRF-R, and sTfR-F index were not associated with the risk of stroke in overall analyses. Conclusion: FET among female, hemoglobin and sTfR-F index among those BMI ≤ 23 kg/m2 may be contributing factors for stroke.

Abstract 16866: Blood Pressure Control and Stroke or Bleeding Risk in Patients with Atrial Fibrillation: Results from the ROCKET AF Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sreekanth Vemulapalli ◽  
Anne S Hellkamp ◽  
W. Schuyler Jones ◽  
Jonathan P Piccini ◽  
Kenneth W Mahaffey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Major Bleeding ◽  
Hemorrhagic Stroke ◽  
Proportional Hazards ◽  
Bleeding Risk ◽  
Cox Proportional Hazards ◽  
Adjusted Risk ◽  
History Of ◽  
Stage 1

Background: Hypertension (HTN) is a risk factor for stroke and bleeding in atrial fibrillation (AF). Yet, the association between HTN stage and stroke and bleeding risk in AF is unknown. Methods: The study population included 14,256 of the patients randomized in the ROCKET AF trial. Baseline systolic blood pressure (SBP) and history of HTN were determined and categorized as follows: (1) no history of HTN, (2) controlled HTN (SBP <140), (3) stage 1 HTN (SBP 140-159), and (4) stage 2 HTN (SBP ≥160). Cox proportional hazards models were used to compare event rates for stroke or systemic embolism (SE) and major bleeding. Results: Of the 90.5% of patients in ROCKET AF with HTN, 55.9% were controlled and 34.6% had stage 1 or 2 HTN. Compared with those with HTN, those without HTN had lower mean CHADS 2 scores (2.8 vs. 3.5), lower rates of prior myocardial infarction (11% vs. 18%), and lower mean age (69 vs. 73 years). Compared with those with no history of HTN, there was a trend towards an increased adjusted risk of stroke or SE in patients with controlled HTN (HR 1.22, 95% CI 0.89-1.66) and stage 1 or 2 HTN (HR 1.42, 95% CI 1.03-1.95) (p=0.06). A similar trend in adjusted risk of hemorrhagic stroke (controlled HTN: HR 2.50, 95% CI 0.89-7.05; stage 1 or 2 HTN: HR 3.04, 95% CI 1.06-8.71) (p=0.11) was observed. The effect of HTN stage on stroke risk did not vary by baseline CHADS 2 score (p interaction=0.70). The adjusted risk of major bleeding was not different between groups (HR 0.96, 95% CI 0.74-1.23; HR 1.00, 95% CI 0.77-1.30) (p=0.84). The benefit of rivaroxaban versus warfarin in preventing stroke or SE was consistent among patients regardless of baseline SBP (p interaction=0.69). Conclusion: One-third of patients in a clinical trial of AF had uncontrolled SBP at baseline. Uncontrolled SBP showed a trend towards a higher risk of stroke or SE, but not bleeding. Uncontrolled SBP may be an important factor in reducing the overall risk of stroke, and specifically hemorrhagic stroke, in patients with AF.

Abstract P156: Association Of Blood Pressure Responses To Submaximal Exercise With Incident Atrial Fibrillation: The Framingham Offspring Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Joowon Lee ◽  
Tara Shrout ◽  
Emelia J Benjamin ◽  
Vasan S Ramachandran ◽  
Vanessa Xanthakis
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Positive Association ◽  
Later Life ◽  
Cox Proportional Hazards ◽  
Submaximal Exercise ◽  
Peak Exercise ◽  
Post Exercise

Introduction: Atrial fibrillation (AF) is the most common arrhythmia and a leading cause of stroke. Blood pressure (BP) responses to submaximal exercise are associated with incident cardiovascular disease and mortality. The association of BP responses to submaximal exercise with incident AF in the community is unknown. Hypothesis: We hypothesized that higher BP during and slower BP recovery after submaximal exercise are associated with a higher risk of incident AF. Methods: We evaluated Framingham Offspring Study participants who attended examination cycle 7, were free of AF, and underwent submaximal treadmill exercise testing. Systolic BP (SBP) and diastolic BP (DBP) were obtained pre-exercise (standing), during exercise (second stage, 2.5 mph at 12% grade), and 3-minutes post-exercise (supine). ΔBP during exercise was defined as exercise BP minus pre-exercise BP. ΔBP during recovery was defined as peak exercise BP minus 3-minutes post-exercise BP. We related exercise BP variables to risk of AF using Cox proportional hazards regression, adjusting for age, sex, height, weight, resting heart rate, resting SBP, resting DBP, use of antihypertensive medication, current smoking status, and diabetes. Results: We studied 2,002 participants (mean age 58 years; 53% women). During a median follow-up of 15 years, 236 participants (39% women) developed AF. We observed a positive association of exercise DBP and ΔDBP during exercise with risk of AF (Hazards Ratio [HR] per standard deviation [SD] increase 1.28, 95% CI 1.12-1.47 and HR 1.22, 95% CI 1.07-1.39, respectively). There was also a positive association between 3 minutes post-exercise SBP and AF risk (HR per SD-increase 1.31, 95% CI 1.07-1.60) and an inverse relation between ΔSBP during recovery and AF risk (HR per SD-increase 0.79, 95% CI 0.66-0.94, Table ) Conclusions: BP responses to submaximal exercise during midlife may serve as a marker for AF risk in later life.

scholarly journals Higher Intakes of Potassium and Magnesium, but Not Lower Sodium, Reduce Cardiovascular Risk in the Framingham Offspring Study

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 269
Author(s):  
R. Taylor Pickering ◽  
M. Loring Bradlee ◽  
Martha R. Singer ◽  
Lynn L. Moore
Keyword(s):  
Dose Response ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Sodium Intake ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Cvd Risk ◽  
Cox Models ◽  
Dietary Fiber Intake

We explored the dose-response relations of sodium, potassium, magnesium and calcium with cardiovascular disease (CVD) risk in the Framingham Offspring Study, as well as the combined effects of these minerals. Analyses included 2362 30–64 year-old men and women free of CVD at baseline. Cox proportional-hazards models were used estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for mineral intakes and incident CVD. Cox models with restricted cubic spline functions were used to examine dose-response relations, adjusting for confounding by age, sex, body mass index, dietary fiber intake, and time-varying occurrence of hypertension. Lower sodium intake (<2500 vs. ≥3500 mg/d) was not associated with a lower risk of CVD. In contrast, potassium intake ≥3000 (vs. <2500) mg/d was associated with a 25% lower risk (95% CI: 0.59, 0.95), while magnesium intake ≥320 (vs. <240) mg/d led to a 34% lower risk (95% CI: 0.51, 0.87) of CVD. Calcium intake ≥700 (vs. <500) mg/d was associated with a non-statistically significant 19% lower risk. Restricted cubic spline curves showed inverse dose-response relations of potassium and magnesium with CVD risk, but no such associations were observed for sodium or calcium. These results highlight the importance of potassium and magnesium to cardiovascular health.

scholarly journals Is Hemoglobin Concentration a Linear Predictor of Mortality in Older Adults From Chinese Longevity Regions?

2021 ◽  
Vol 9 ◽  
Author(s):  
Jiaojiao Ren ◽  
Zhenghe Wang ◽  
Yujie Zhang ◽  
Peidong Zhang ◽  
Jianmeng Zhou ◽  
...  
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Reference Group ◽  
Hemoglobin Concentration ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Cox Models ◽  
Linear Predictor ◽  
All Cause Mortality ◽  
Hb Concentration

Introduction: The association patterns of hemoglobin (HB) concentrations with mortality among the longevity older adults are unclear. We aimed to evaluate the relationship among older adults form Chinese longevity regions.Methods: We included 1,785 older adults aged ≥65 years (mean age, 86.7 years; 1,002 women, 783 men) from the community-based Chinese Longitudinal Healthy Longevity Survey. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality using multivariable Cox proportional hazards models and Cox models with restricted cubic spline.Results: In total, 999 deaths occurred during a median follow-up of 5.4 years from 2011 to 2017. Restricted cubic spline analysis found no non-linear association between HB concentrations and all-cause mortality after a full adjustment for covariates among the older adults form longevity regions (p &gt; 0.05 for non-linearity). The risk for all-cause mortality was significantly higher in the groups with HB concentration of &lt;11.0 g/dL (HR: 1.37, 95% CI: 1.10–1.70) and 11.0–12.0 g/dL (HR: 1.25, 95% CI: 1.01–1.54); the risk of all-cause mortality was significantly lower in the groups with HB concentration ≥14.0 g/dL (HR: 0.76, 95% CI: 0.60–0.97) compared with the reference group (13.0–13.9 g/dL).Conclusions: Among older adults form Chinese longevity regions, HB concentrations were found to be inversely and linearly associated with all-cause mortality. Further prospective intervention trials are needed to confirm whether higher HB concentrations had a lower risk of mortality in these older adults.

scholarly journals Positive Association Between Serum Alkaline Phosphatase and First Stroke in Hypertensive Adults

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuanyuan Zhang ◽  
Huan Li ◽  
Di Xie ◽  
Jianping Li ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Alkaline Phosphatase ◽  
Primary Outcome ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Serum Alkaline Phosphatase ◽  
Positive Association ◽  
Normal Range ◽  
Glucose Levels

The relation of alkaline phosphatase (ALP) with stroke risk remains uncertain. We aimed to examine the association between serum ALP and the risk of first stroke, and explore the possible effect modifiers in the association, among adults with hypertension. A total of 19,747 participants with baseline ALP measurements and without liver disease at baseline from the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was a first stroke. Over a median follow-up of 4.5 years, there was a positive association between serum ALP levels and the risk of first stroke (per SD increment, adjusted HR, 1.10; 95%CI: 1.01, 1.20). When serum ALP was evaluated as quartiles, a significantly higher risk of first stroke was observed in those in quartile 2–4 (ALP ≥79 IU/L; adjusted HR, 1.38; 95% CI: 1.11, 1.71), compared with participants in quartile 1 (ALP &lt;79 IU/L). Similar results were found for first ischemic or hemorrhagic stroke. Similar findings were also found in those with a normal range of baseline ALP levels (20–140 IU/L) (per SD increment, adjusted HR, 1.15; 95%CI: 1.05, 1.27). None of the variables, including sex, age, body mass index, smoking, alcohol drinking, blood pressure, total cholesterol, fasting glucose levels at baseline, and blood pressure levels during the treatment period, significantly modified the association. In summary, our study suggests that higher serum ALP levels, even in normal range, were significantly related to higher risk of first stroke among Chinese hypertensive adults.

scholarly journals Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1514
Author(s):  
Hilde Espnes ◽  
Jocasta Ball ◽  
Maja-Lisa Løchen ◽  
Tom Wilsgaard ◽  
Inger Njølstad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Pressure Management ◽  
Reference Models ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

Consumption of flavonoid-rich fruits, flavonoids from fruits, and stroke risk: a prospective cohort study

2021 ◽  
pp. 1-26
Author(s):  
Qi Gao ◽  
Jia-Yi Dong ◽  
Renzhe Cui ◽  
Isao Muraki ◽  
Kazumasa Yamagishi ◽  
...  
Keyword(s):  
Lower Risk ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dietary Factors ◽  
Citrus Fruits ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Index Study

Abstract We sought to examine the prospective associations of specific fruit consumption, in particular flavonoid-rich fruit (FRF) consumption, with the risk of stroke and subtypes of stroke in a Japanese population. A study followed a total of 39,843 men and 47,334 women aged 44-76 years, and free of cardiovascular disease, diabetes, and cancer at baseline since 1995 and 1998 to the end of 2009 and 2012, respectively. Data on total and specific FRF consumption for each participant were obtained using a self-administrated food frequency questionnaire. The hazard ratios (HRs) of stroke in relation to total and specific FRF consumption were estimated through Cox proportional hazards regression models. During a median follow-up of 13.1 years, 4092 incident stroke cases (2557 cerebral infarctions and 1516 hemorrhagic strokes) were documented. After adjustment for age, body mass index, study area, lifestyles, dietary factors, and other risk factors, it was found that total FRF consumption was associated with a significantly lower risk of stroke in women (HR= 0.70; 95% CI, 0.58-0.84), while the association in men was not significant (HR= 0.93; 95% CI, 0.79-1.09). As for specific FRFs, consumptions of citrus fruits, strawberries, and grapes were found associated with a lower stroke risk in women. Higher consumptions of FRFs, in particular citrus fruits, strawberries, and grapes, were associated with a lower risk of developing stroke in Japanese women.

Abstract MP012: Plasma Galectin-3 Levels and Subsequent Risk of Incident Chronic Kidney Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Casey M Rebholz ◽  
Elizabeth Selvin ◽  
Menglu Liang ◽  
Christie M Ballantyne ◽  
Ron C Hoogeveen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards ◽  
Disease Risk ◽  
Positive Association ◽  
Cox Proportional Hazards ◽  
Diabetes Status ◽  
Incident Chronic Kidney Disease ◽  
Galectin 3

Introduction: Galectin-3 is a 35 kDa β-galactoside-binding lectin which has been proposed as a novel biomarker of heart failure primarily due to its involvement in myocardial fibrosis. Elevated levels of galectin-3 may be associated with fibrosis of other organs, such as the kidney, and increase the risk of developing kidney disease. Methods: Using Cox proportional hazards regression, we prospectively analyzed Atherosclerosis Risk in Communities (ARIC) study participants with measurements of plasma galectin-3 levels at baseline (visit 4, 1996-98) and without prevalent kidney disease or heart failure (N=9,647). Incident chronic kidney disease was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m 2 accompanied by 25% eGFR decline, chronic kidney disease-related hospitalization or death, or end-stage renal disease between baseline and December 31, 2013. Results: 2,105 participants (22%) developed incident chronic kidney disease over a median follow-up of 16 years. The mean (standard deviation) plasma level of galectin-3 was 14.7 (4.4) ng/mL. At baseline, galectin-3 was cross-sectionally associated with eGFR (r = -0.31) and urine albumin-to-creatinine ratio (UACR) (r = 0.19). After adjusting for demographics and kidney disease risk factors, there was a significant, graded, and positive association between galectin-3 and incident chronic kidney disease (quartile 4 vs. 1 HR: 1.84, 95% CI: 1.62, 2.09, p for trend <0.001). The association between galectin-3 and incident chronic kidney disease was attenuated but remained significant after accounting for eGFR and UACR (quartile 4 vs. 1 HR: 1.58, 95% CI: 1.39, 1.80, p for trend <0.001). The association was similar by diabetes status (p for interaction = 0.33) and stronger among those with hypertension (p for interaction = 0.004). Conclusion: In this community-based population, higher plasma galectin-3 levels were associated with elevated risk of developing incident chronic kidney disease, particularly among those with hypertension.

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