TitleAssessment of the Role of Carotid Atherosclerosis in the Association Between Major Cardiovascular Risk Factors and Ischemic Stroke Subtypes
AuthorsParish, Sarah
Arnold, Matthew
Clarke, Robert
Du, Huaidong
Wan, Eric
Kurmi, Om
Chen, Yiping
Guo, Yu
Bian, Zheng
Collins, Rory
Li, Liming
Chen, Zhengming
Chen, Junshi
Lv, Jun
Peto, Richard
Walters, Robin
Avery, Daniel
Bennett, Derrick
Boxall, Ruth
Bragg, Fiona
Chang, Yumei
Gilbert, Simon
Hacker, Alex
Holmes, Michael
Kartsonaki, Christiana
Kerosi, Rene
Lancaster, Garry
Lin, Kuang
McDonnell, John
Millwood, Iona
Nie, Qunhua
Yao, Pang
Ryder, Paul
Sansome, Sam
Schmidt, Dan
Sohoni, Rajani
Turnbull, Iain
Walters, Robin
Wang, Jenny
Wang, Lin
Wright, Neil
Yang, Ling
Yang, Xiaoming
Han, Xiao
Hou, Can
Jing, Biao
Liu, Chao
Lv, Jun
Pei
Tan, Yunlong
Yu, Canqing
Pang, Zengchang
Gao, Ruqin
Li, Shanpeng
Wang, Shaojie
Liu, Yongmei
Du, Ranran
Zang, Yajing
Cheng, Liang
Tian, Xiaocao
Zhang, Hua
Zhai, Yaoming
Ning, Feng
Sun, Xiaohui
Li, Feifei
Lv, Silu
Wang, Junzheng
Hou, Wei
Zeng, Mingyuan
Jiang, Ge
Zhou, Xue
Yang, Liqiu
He, Hui
Yu, Bo
Li, Yanjie
Xu, Qinai
Kang, Quan
Guo, Ziyan
Wang, Dan
Hu, Ximin
Wang, Hongmei
Chen, Jinyan
Fu, Yan
Fu, Zhenwang
Wang, Xiaohuan
Weng, Min
Guo, Zhendong
Wu, Shukuan
Li, Yilei
Li, Huimei
Fu, Zhifang
Wu, Ming
Zhou, Yonglin
Zhou, Jinyi
Tao, Ran
Yang, Jie
Su, Jian
Liu, Fang
Zhang, Jun
Hu, Yihe
Lu, Yan
Ma, Liangcai
Tang, Aiyu
Zhang, Shuo
Jin, Jianrong
Liu, Jingchao
Tang, Zhenzhu
Chen, Naying
Huang, Ying
Li, Mingqiang
Meng, Jinhuai
Pan, Rong
Jiang, Qilian
Lan, Jian
Liu, Yun
Wei, Liuping
Zhou, Liyuan
Chen, Ningyu
Wang, Ping
Meng, Fanwen
Qin, Yulu
Wang, Sisi
Wu, Xianping
Zhang, Ningmei
Chen, Xiaofang
Zhou, Weiwei
Luo, Guojin
Li, Jianguo
Chen, Xiaofang
Zhong, Xunfu
Liu, Jiaqiu
Sun, Qiang
Ge, Pengfei
Ren, Xiaolan
Dong, Caixia
Zhang, Hui
Mao, Enke
Wang, Xiaoping
Wang, Tao
Zhang, Xi
Zhang, Ding
Zhou, Gang
Feng, Shixian
Chang, Liang
Fan, Lei
Gao, Yulian
He, Tianyou
Sun, Huarong
He, Pan
Hu, Chen
Zhang, Xukui
Wu, Huifang
He, Pan
Yu, Min
Hu, Ruying
Wang, Hao
Qian, Yijian
Wang, Chunmei
Xie, Kaixu
Chen, Lingli
Zhang, Yidan
Pan, Dongxia
Gu, Qijun
Huang, Yuelong
Chen, Biyun
Yin, Li
Liu, Huilin
Fu, Zhongxi
Xu, Qiaohua
Xu, Xin
Zhang, Hao
Long, Huajun
Li, Xianzhi
Zhang, Libo
Qiu, Zhe
AffiliationUniv Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Univ Oxford, MRC, Populat Hlth Res Unit, Nuffield Dept Populat Hlth, Oxford, England
Chinese Acad Med Sci, Beijing, Peoples R China
Peking Univ, Hlth Sci Ctr, Dept Epidemiol & Biostat, Sch Publ Hlth, Beijing, Peoples R China
Issue Date2019
PublisherJAMA NETWORK OPEN
AbstractIMPORTANCE A better understanding of the role of atherosclerosis in the development of ischemic stroke subtypes could help to improve strategies for prevention of stroke worldwide. OBJECTIVE To assess the role of carotid atherosclerosis in the association between major cardiovascular risk factors and ischemic stroke subtypes. DESIGN, SETTING, AND PARTICIPANTS The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey obtained between June 2004 and July 2008. A random sample of 23 973 participants with no history of cardiovascular disease at enrollment who had carotid artery ultrasonographic measurements recorded at a resurvey from September 2013 to June 2014 were included. Data analysis was performed from July 1, 2016, to April 10, 2019. EXPOSURES Major cardiovascular risk factors (ie, blood pressure [BP], blood lipid levels, smoking, and diabetes). MAIN OUTCOMES AND MEASURES Carotid ultrasonographic measures of plaque burden (derived from number and maximum size of carotid artery plaques at resurvey) and first ischemic stroke during follow-up (n = 952), with subtyping (data release, August 2018) as lacunar (n = 263), probable large artery (n = 193), probable cardioembolic (n = 66), or unconfirmed (n = 430). Associations between cardiovascular risk factors, carotid plaque burden, and ischemic stroke subtypes were adjusted for age, sex, and geographic area. RESULTS The 23 973 participants in the study had a mean (SD) age of 50.6 (10.0) years, and 14 833 (61.9%) were women. Systolic BP had a stronger association (odds ratio [OR] per SD, 1.51; 95% CI, 1.42-1.61) than plaque burden (OR per SD, 1.34; 95% CI, 1.26-1.44) with ischemic stroke, and the associations of systolic BP with each subtype of ischemic stroke were modestly attenuated by adjustment for plaque burden. After adjustment for BP, plaque burden had a stronger association with probable large artery stroke (OR, 1.43; 95% CI, 1.24-1.63) than with lacunar stroke (OR, 1.25; 95% CI, 1.10-1.43) but was not associated with probable cardioembolic stroke (OR, 1.06; 95% CI, 0.83-1.36). CONCLUSIONS AND RELEVANCE Although BP was an important risk factor for all ischemic stroke subtypes, carotid atherosclerosis was an important risk factor only for large artery and lacunar strokes, suggesting that drug treatments targeting atherosclerosis may reduce the risk of stroke subtypes to different extents.
URIhttp://hdl.handle.net/20.500.11897/543632
ISSN2574-3805
DOI10.1001/jamanetworkopen.2019.4873
IndexedESCI
Appears in Collections:医学部待认领

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