Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China.

Qianqian Wu,Xiaofei Hu,Min Wang,Jingjing Cui,Huifang Zhang,Fenghua Jiang,Yuanli Xie

doi:10.3389/fneur.2021.642426

Abstract

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

Highlights

Stroke affects more than 10 million people worldwide annually and is the second-most common cause of death and the thirdmost common cause of long-term disability [1]
Different studies on the prognosis and risk factors of ischemic stroke subtypes have shown that dyslipidemia, hypertension, diabetes, and obesity affect the prevalence of stroke and stroke-related mortality [7,8,9]
The results of the present study showed that elevated fasting plasma glucose (FPG) level was an independent risk factor for 3- and 12-month outcomes, further illustrating that high FPG level is a strong prediction factor for poor outcomes of Large-artery atherosclerotic (LAA) stroke; early intervention and management should be considered to improve LAA stroke prognosis

Summary

Introduction

Stroke affects more than 10 million people worldwide annually and is the second-most common cause of death and the thirdmost common cause of long-term disability [1]. Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke, especially among Asian population accounting for about 33%, LAA increasing fastest among all subtypes reaching 5.7% annually [3]. Underlying mechanisms of stroke caused by large atherosclerosis are diverse, including arterial-to-arterial emboli, in situ thromboembolism, hemodynamic impairment, and branching occlusive disease (BOD), and lesions could be in the lacunae, subcortical, cortical, or these bindings [6]. Different studies on the prognosis and risk factors of ischemic stroke subtypes have shown that dyslipidemia, hypertension, diabetes, and obesity affect the prevalence of stroke and stroke-related mortality [7,8,9]. Other traditional cardiovascular risk factors such as sex, race, smoking, alcohol consumption, risk-reducing medication, blood glucose level, and obesity can increase the progression of atherosclerosis and affect the prognosis of this subtype of stroke [10]. Homocysteine and hs-CRP levels have predicted stroke-related mortality [11, 12]

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