Lipid-related indices and stroke risk among middle-aged and older Chinese adults: A nationwide cross-sectional and longitudinal study.

National cohort study on cardiometabolic index and incident stroke in middle-aged and older adults in China.

The burden of ischemic stroke among middle-aged and older adults in China from 1990 to 2023 and future projections.

The epidemiological transition of first-ever stroke among low-income population in China: a population-based study from 1992 to 2014

Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are often examined separately. We assessed baseline cardiometabolic, adiposity-related, and psychosocial factors associated with first reported incident stroke in a longitudinal China Health and Retirement Longitudinal Study (CHARLS) cohort. We used CHARLS data. Participants aged 45 years or older who were free of stroke at baseline and had at least one follow-up assessment were eligible. A person-period dataset was constructed to incorporate repeated follow-up intervals and the timing of first reported incident stroke. Person-period modified Poisson regression models with participant-level cluster-robust standard errors were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Among 15,992 eligible participants, 1,246 first reported incident stroke events were identified during follow-up. The body mass index (BMI) and waist circumference complete-case models included 11,674 and 11,604 participants, with 949 and 941 incident stroke events, respectively. In the BMI model, hypertension (RR, 1.80; 95% CI, 1.56-2.07), diabetes (RR, 1.51; 95% CI, 1.21-1.88), heart problems (RR, 1.39; 95% CI, 1.17-1.64), BMI (RR per 1kg/m², 1.05; 95% CI, 1.03-1.06), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score (RR per 1 point, 1.03; 95% CI, 1.02-1.04) were associated with increased stroke risk. In the waist circumference model, waist circumference was also positively associated with incident stroke (RR per 1cm, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses yielded broadly consistent results. Hypertension, diabetes, heart problems, higher BMI, larger waist circumference, and higher CESD-10 score were associated with increased risk of first reported incident stroke among middle-aged and older Chinese adults. These observational findings suggest that vascular, adiposity-related, and psychosocial factors may help characterize stroke risk in this population, but they should be interpreted cautiously given anthropometric missingness, self-reported stroke ascertainment, and potential residual confounding.

Both triglyceride-glucose (TyG) index and residual cholesterol (RC) are predictors of stroke; however, to what extent the RC is associated with stroke through TyG index is unclear. This study examined whether the TyG index mediates the association of RC with incident stroke and the extent of interaction or joint relations of RC and TyG index with stroke in middle-aged and older Chinese adults. This is an ongoing prospective cohort study initiated in 2011 that included 10,569 middle-aged and older Chinese adults without stroke at baseline. The exposure was RC, the mediator was TyG index, and the outcome was stroke which followed up from June, 2011, to June, 2018. Mediation analysis was used to explore whether the TyG index mediated the association between RC and stroke risk. Of the 10,569 participants, 4,978 (47.1%) were men; the mean (SD) age was 59.01 (9.43) years. During a median follow-up of 7.1 years, 734 (7.0%) participants experienced a stroke. In the adjusted Cox models, A one SD increase in RC was associated with an elevated risk of stroke (HR, 1.09; 95% CI, 1.02-1.16), as well as TyG index (HR, 1.14; 95% CI, 1.06-1.23). No significant multiplicative or additive interactions were found between the TyG index and RC on stroke risk (HR for multiplicative: 1.07, 95% CI, 0.67-1.70; Synergy index: 1.05, 95% CI, 0.16-6.88). TyG index mediated the association between RC and stroke (b, -0.16; 95% CI, -0.30 to -0.03). Subgroup analyses and sensitivity analyses showed consistent results. This study evidence that the TyG index completely mediates the association between RC and stroke risk among middle-aged and older Chinese adults. These findings highlight the importance of considering RC and the TyG index in stroke risk assessment.

Establishing associations between residential greenness and markers of adiposity among middle-aged and older Chinese adults through multilevel structural equation models.

Objective:We aimed to obtain more precise estimates of stroke to address the wide variation of stroke burden among people with HIV (PWH) in different clinical settings.Design:Systematic review and meta-analysis.Methods:We systematically searched PubMed, EMBASE, and Web of Science for original articles reporting the prevalence and incidence of stroke among PWH up to November 23, 2022. Der Simonian-Laird random effects were used to obtain pooled estimates and 95% confidence intervals (CIs).Results:We included 17 observational studies covering 1 749 003 PWH on estimation of prevalence, and 17 cohort studies covering 249 606 PWH on estimation of incidence. The pooled prevalence of stroke was 1.30% (95% CI: 1.01%, 1.59%) for PWH aged at least 15 years, and 3.98% (95% CI: 2.45%, 5.51%) for PWH aged at least 50 years. The pooled incidence of stroke was 17.86 per 10 000 person-years (95% CI: 15.96, 19.76), meanwhile, the pooled incidence of ischemic stroke (31.50 per 10 000 person-years; 95% CI: 11.11, 51.89) was higher than hemorrhagic stroke (4.43 per 10 000 person-years; 95% CI: 1.95, 6.91) among PWH aged at least 15 years.Conclusion:The prevalence of stroke was nearly one per hundred among PWH aged ≥15 years, and reached four per hundred for those aged ≥50 years. The occurrence of stroke is common during HIV progression, particularly ischemic stroke. Therefore, more efforts should be made on implementing policies, strategies, and programs aimed at identifying the risk factors, improving treatment, and facilitating rehabilitation for stroke to reduce the disease burden among PWH.

Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

ResumenFundamento: El ictus es la segunda causa de muerte y la primera causa de discapacidad en Europa. El número de pacientes con ictus muestra una tendencia de crecimiento rápido debido al aumento de la población anciana. El objetivo de este metaanálisis es estimar la prevalencia e incidencia de ictus en Europa.Método: Se buscaron artículos en las bases de datos MEDLINE, SCOPUS, CINAHL Complete y EMBASE con los términos “stroke”, “cerebrovascular accident” combinadas con “epidemiology”, “prevalence”, “incidence” y “Europe”. La calidad y el riesgo de sesgo se analizó con las escalas Hoy modificada y Newcastle Ottawa para los artículos de prevalencia e incidencia, respectivamente. El metaanálisis utilizó un modelo de efectos aleatorios con intervalos de confianza del 95% (IC95%) y el estadístico I2 para estimar la heterogeneidad.Resultados: La prevalencia de ictus en Europa ajustada por sexo fue 9,2% (IC95%: 4,4-14,0); en hombres fue 9,1% (IC95%: 4,7-16,6) y en mujeres 9,2% (IC95%: 4,1-14,4); se encontró una tendencia creciente con el aumento de la edad. La incidencia de ictus ajustada por sexo fue 191,9 por 100.000 personas-año (IC95%: 156,4-227,3); en hombres fue de 195,7 por 100.000 personas-año (IC95%: 142,4-249,0) y en mujeres 188,1 por 100.000 personas-año (IC95%: 138,6-237,7), con igual tendencia creciente con el aumento de la edad.Conclusiones: La prevalencia de ictus en Europa alcanza un 9,2%. La incidencia se sitúa en 191,9 por 100.000 personas-año. La prevalencia de ictus ha aumentado mientras que la incidencia se mantiene estable en comparación con estudios realizados a comienzos del siglo XXI.

BackgroundThe triple digital divide refers to the lack of internet access, use and knowledge among specific populations. In China, middle-aged and older adults and those living in rural areas or...

BackgroundCognitive impairment (CI), an early sign of Alzheimer's disease, may be identified using the metabolic score for insulin resistance (METS-IR), a novel insulin resistance marker.ObjectiveThis nationwide cohort study in China examined the association between METS-IR and CI in middle-aged and older adults, providing preliminary evidence for early prevention.MethodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2015. METS-IR was calculated using fasting plasma glucose, triglycerides, body mass index, and high-density lipoprotein cholesterol. CI was evaluated through episodic memory and mental status. Descriptive statistics, multivariable logistic regression, restricted cubic spline (RCS), subgroup, and interaction analyses were used to assess the association of METS-IR with CI, with sensitivity analysis confirming robustness.ResultsThe study included 5842 middle-aged and older adults in China. The incidence of CI throughout the follow-up period was 14.36%. The multivariable logistic regression models indicated that participants in Q3 and Q4 of METS-IR had 1.375-fold and 1.564-fold higher risks of CI, respectively, compared with those in Q1 (Q3: OR = 1.375, 95% CI = 1.075-1.758; Q4: OR = 1.564, 95% CI = 1.220-2.005). The trend analysis of METS-IR was also statistically significant. A substantial linear relation between METS-IR and CI was confirmed by the RCS analysis (p for nonlinearity = 0.462). Moreover, consistent associations were observed across extensive subgroup analyses.ConclusionsElevated METS-IR levels were significantly associated with increased CI risk in middle-aged and older Chinese adults. These findings provide support for early identification and intervention of CI.

Dose-response relationship between cumulative average depressive symptoms and cardiovascular disease incidence in middle-aged and older Chinese adults: A 7-year prospective cohort study.

Introduction: Galectin-4 (Gal-4) is a small protein in the gastrointestinal tract. It has been implicated in diabetes mellitus, incident coronary events, incident heart failure as well as all-cause and cardiovascular mortality. However, possible associations of Gal-4 with stroke have not yet been examined. Hypothesis: We explored if Gal-4 is associated with prevalent and incident stroke in a large population cohort. Methods: Gal-4 was analyzed by the proximity extension assay technique in 1737 participants from a subsample of the population-based Malmö Preventive Project (mean age 67 years, 29% women). Stroke was defined as all strokes (ischemic, hemorrhagic and undefined). Multivariable logistic regression models were applied for prevalent stroke (n=72). Prior to analyses of incident stroke, cases of prevalent stroke were excluded. Multivariate Cox regression models were applied for incident stroke. Results: Gal-4 levels were significantly higher in subjects with prevalent stroke (p=0.003) than in subjects free from prevalent stroke. Gal-4 (per doubling of concentration) was significantly associated with prevalent stroke in age and sex adjusted models (odds ratio 1.49; 95% confidence interval (1.04-2.14); p=0.032), but the associations was no longer significant upon further adjustment for traditional risk factors for stroke (OR 1.22 (0.82-1.82), p=0.339). Further, each doubling in Gal-4 concentration was associated with higher risk of incident stroke (n=1604; 327 events; median follow up time 12.6 (interquartile range 10.0-13.6) years; hazard ratio 1.24 (1.02-1.49); p=0.027) in a model adjusted for BMI, systolic blood pressure, triglycerides, HDL-cholesterol, smoking, diabetes, prevalent coronary events and anti-hypertensive treatment. Conclusions: In a large population cohort, Gal-4 was associated with incident stroke during a follow-up of 12 years, further implicating a role of Gal-4 in both cardiovascular and metabolic disease.

Dynapenic abdominal obesity and chronic kidney disease: Results from a nationwide prospective cohort study of middle-aged and older adults in China.

The Relationship Between Sleep Duration and Cardiovascular Disease: A Prospective Cohort Study Based on Charls.