《柳叶刀》宣布中风可预防,10大风险因素需注意
生物通 · 2016/07/24
世界上每年都有数百万人因为中风而死亡,还有更多的人因为中风永久性残疾。这种毁灭性的疾病常常毫无征兆地发生,令患者突然丧失了独立生活的能力(语言手和运动能力受损)。顶级医疗期刊《柳叶刀》最近发表的两篇文章显示,中风在很大程度上是可以预防的。


世界上每年都有数百万人因为中风而死亡,还有更多的人因为中风永久性残疾。这种毁灭性的疾病常常毫无征兆地发生,令患者突然丧失了独立生活的能力(语言手和运动能力受损)。顶级医疗期刊《柳叶刀》最近发表的两篇文章显示,中风在很大程度上是可以预防的。

中风是指由于脑部供血受阻而迅速发展成的脑功能损失,是世界上的第二大致死疾病。中风主要分为两种类型,由血栓或栓塞所造成的缺血性中风占85%,由大脑出血造成的出血性中风占15%。预防中风一直是公共医疗卫生的一项重要任务。

McMaster大学PHRI的研究人员发现,全世界90%的中风取决于10个可改变的因素不过。这些风险因子的作用大小存在地域差异,可能影响各地制定的中风预防策略。这项研究主要基于INTERSTROKE项目第一阶段的发现,涉及欧洲、亚洲、美洲、非洲、澳洲22个国家的两万多人,包括青人和老年、男性和女性。

“这项研究在全球主要区域和关键人群中寻找中风的风险因子,”PHRI的Martin O'Donnell教授介绍道。“我们确认,90%的中风病例与10个可改变的风险因子有关。高血压在各地都是最重要的一个中风风险因子,也是减轻全球中风负担的关键靶标。”

研究显示,排除高血压会使中风人数减少一半(48%)。如果大家都积极进行体育运动,中风人数会减少三分之一(36%)。健康饮食能让中风人数减少五分之一(19%),戒烟能让中风人数减少12%。排除心血管因素、糖尿病、饮酒、压力和脂肪因素,中风人数会分别减少9%、4%、6%、6%和27%。 (the study used apolipoproteins, which was found to be a better predictor of stroke than total cholesterol). 其中不少风险因子是相互关联的,比如肥胖和糖尿病。十个风险因子结合起来

人群归因危险度百分比(PARP)也叫人群病因分值,是指人群内,某种疾病的发病率中,归因于某种暴露引起的发病占全部发病的百分比,

值得注意的是,这些风险因子在不同地区起到了不同程度的作用。举例来说,西欧、北美和澳大利亚人的中风有40%归因于高血压,而这个比例在东南亚是60%。酒精在西欧、北美和澳大利亚起到的作用最小,在非洲和南亚作用最大。而缺乏锻炼在中国影响最大。

心律不齐或心房颤动在所有地区都与缺血性中风有显著关联,但在西欧、北美和澳大利亚影响更大(相比于中国和南亚)。不过,这十个风险因子的总体重要性在各个地区都是差不多的。这项研究有助于根据不同人群制定预防中风的干预策略,比如展开更好的健康教育,减少吸烟者,提供更便宜的健康食品、高血压药和血脂紊乱药物。

《柳叶刀》同期还发表了新西兰研究者Valery L. Feigin和Rita Krishnamurthi的评论文章。他们在文章中表示,这项研究说明中风是一种高度可预防的疾病,不论年龄和性别。风险因子的重要性差异意味着我们应当根据地域或民族制定中风预防程序。此外,我们应该对INTERSTROKE项目未涉及的国家和民族展开进一步的研究。文章还指出,政府、卫生组织和我们每一个人是时候对中风主动出击了。

去年一个跨国团队发现,去除引发严重中风的血栓同时进行标准的药物治疗,能够显著改善大脑供血达到更好的治疗效果。研究人员指出,这一发现将会彻底改变我们治疗中风的方式,让更多患者能够在中风后独立照料自己的生活。这项研究发表在顶级医学杂志《新英格兰医学》上。

为了明确工作时间对心血管疾病的影响,伦敦大学学院的Mika Kivimäki教授领导研究团队进行了大规模的研究。他们在《柳叶刀》上发表文章指出,工作时间长会显著提升中风和冠心病的患病风险。由此可见,加班加点地工作的确不利于健康,甚至会危及你的生命。

前不久Weill Cornell医学院的研究人员发现,特定肠道菌能利用免疫系统减轻中风的严重性。中风是世界上第二大致死疾病,每年都有数百万人因为中风而死亡,还有更多的人因为中风永久性残疾。这种毁灭性的疾病常常毫无征兆地发生,令患者突然丧失独立生活的能力。

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  • Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

    Background Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. Methods We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Findings Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72–3·28; PAR 47·9%, 99% CI 45·1–50·6), regular physical activity (0·60, 0·52–0·70; 35·8%, 27·7–44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65–2·06 for highest vs lowest tertile; 26·8%, 22·2–31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53–0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2–28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27–1·64 for highest vs lowest tertile; 18·6%, 13·3–25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78–2·72; 17·4%, 13·1–22·6), current smoking (1·67, 1·49–1·87; 12·4%, 10·2–14·9), cardiac causes (3·17, 2·68–3·75; 9·1%, 8·0–10·2), alcohol consumption (2·09, 1·64–2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4–9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05–1·30; 3·9%, 1·9–7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001).

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