Clinical factors in patients with ischemic versus hemorrhagic stroke in East China

Abstract

Abstract:

BACKGROUND: Stroke is one of the leading causes of mortality and morbidity of vascular diseases, and its incidence maintains at a high level around the world. In China, stroke has been a major public health problem. Because the pathogenesis of ischemic stroke is different from that of hemorrhagic stroke, their clinical factors would not be the same. Therefore to investigate the different effects of various effect factors on ischemic versus hemorrhagic stroke and then to enhance the prevention are crucial to decrease the incidence.
METHODS: A total of 692 patients, consisting of 540 ischemic stroke patients and 152 hemorrhagic stroke patients from East China, were included in this study. The related factors of stroke subtypes were collected and analyzed.
RESULTS: The factors significantly associated with ischemic stroke as opposed to hemorrhagic stroke were family history of stroke, obesity, atherosclerotic plaque of the common carotid artery, atrial fibrillation, hyperfibrinogenemia, transient ischemic attack (TIA), atherosclerotic plaque of the internal carotid artery, coronary heart, lower high-density lipoproteins (lower HDL), increasing age, diabetes mellitus, and gender (male) (P<0.05). Leukocytosis, hypertension and family history of hypertension were the significant factors associated with hemorrhagic stroke versus ischemic stroke. Smoking, drinking, kidney diseases and lower HDL-C were the significant factors contributing to ischemic stroke in man. Obesity, family history of hypertension, family history of stroke, hypercholesteremia and myocardial ischemia were the significant factors for females with ischemic stroke.
CONCLUSIONS: The most prominent factors for overall stroke in East China were hypertension, followed by higher pulse pressure and hypercholesteremia. The factors for ischemic and hemorrhagic stroke are not the same. Different effects of risk factors on stroke are found in male and female patients.

Key words: Ischemic stroke, Hemorrhagic stroke, Risk factors

Jing Zhang, Yao Wang, Gan-nan Wang, Hao Sun, Tao Sun, Jian-quan Shi, Hang Xiao, Jin-song Zhang. Clinical factors in patients with ischemic versus hemorrhagic stroke in East China[J]. World Journal of Emergency Medicine, 2011, 2(1): 18-23.

Figures/Tables 5

Figure 1.

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Clinical data	Ischemic patients (n=540)	Hemorrhagic patients (n=152)	P
BMI (kg/m²)	24.05 ± 3.17	23.86 ± 2.43	0.488
SBP (mmHg)	142.35 ± 22.10	154.76 ± 28.67	0.000
DBP (mmHg)	84.59 ± 25.24	91.23 ± 18.75	0.003
WBC (×10⁹/L)	7.38 ± 3.80	9.72 ± 4.35	0.000
NE (%)	65.09 ± 12.61	74.29 ± 12.43	0.000
BG (mmol/L)	6.52 ± 2.63	7.06 ± 2.74	0.028
TG (mmol/L)	4.68 ± 1.24	4.70 ± 1.06	0.841
TC (mmol/L)	1.71 ± 1.18	1.75 ± 1.26	0.724
HDL (mmol/L)	1.15 ± 0.33	1.26 ± 0.36	0.001
PT (s)	12.99 ± 2.53	13.74 ± 2.81	0.002
FIB (g/L)	3.16 ± 1.78	2.98 ± 0.88	0.223

Risk factors	Ischemic patients (n=540)	Hemorrhagic patients (n=152)	χ²	P
Advanced age	420 (77.78)	96 (63.16)	13.368	0.000
Male	322 (59.63)	106 (69.74)	5.135	0.023
Cigarette smoking	126 (23.33)	41 (26.97)	0.859	0.354
Alcohol drinking	86 (15.93)	40 (26.32)	8.598	0.003
Obesity	51 (9.44)	3 (1.97)	9.201	0.001
Elevated SBP	308 (57.04)	108 (71.05)	9.718	0.002
Elevated DBP	209 (38.70)	84 (55.26)	13.323	0.000
Increased pulse pressure	505 (93.52)	144 (94.74)	0.302	0.583
Family history of hypertension	124 (22.96)	48 (31.58)	4.714	0.030
Family history of DM	40 (7.41)	12 (7.89)	0.041	0.841
Family history of stroke	53 (9.81)	5 (3.29)	6.577	0.010
Family history of CAD	33 (6.11)	5 (3.29)	1.820	0.177
Hypertension	407 (75.37)	132 (86.84)	9.064	0.003
DM	172 (31.85)	30 (19.74)	8.423	0.004
TIA	55 (10.19)	6 (3.95)	5.742	0.017
CAD	90 (16.67)	10 (6.58)	9.764	0.002
Valvular heart diseases	11 (2.04)	2 (1.32)	0.335	0.744
AF	68 (12.59)	6 (3.95)	9.283	0.002
Peripheral arterial thrombosis	10 (1.85)	0 (0)	2.856	0.129
Peptic ulcer disease	21 (3.89)	4 (2.63)	0.539	0.624
Kidney disease	26 (4.81)	1 (0.66)	5.466	0.016
Increased WBC	79 (14.63)	62 (40.79)	50.031	0.000
Hyperfibrinogenemia	87 (16.11)	11 (7.24)	7.684	0.006
Hypertriglyceridemia	97 (17.96)	30 (19.74)	0.249	0.618
Hypercholesterolemia	199 (36.85)	58 (38.16)	0.087	0.769
Low level of HDL	184 (34.07)	30 (19.74)	11.424	0.001
The formation of carotid atheroma	73 (13.52)	7 (4.61)	9.217	0.002
The formation of common carotid atheroma	101 (18.70)	8 (5.26)	16.147	0.000
Vertebral artery stenosis	29 (5.37)	1 (0.66)	6.351	0.011
Ischemic ECG changes	73 (13.52)	19 (12.50)	0.107	0.744
ECG arrhythmia	107 (19.81)	21 (13.82)	2.831	0.092

Risk factors	OR (versus hemorrhagic patients)	95% CI	P
Advanced age	2.122	1.335-3.374	0.002
Male	1.593	1.006-2.523	0.047
Obesity	4.863	1.313-18.005	0.018
Family history of hypertension	0.473	0.290-0.788	0.004
Family history of stroke	5.548	1.861-16.539	0.002
Hypertension	0.401	0.224-0.718	0.002
DM	1.687	1.011-2.814	0.045
AF	3.407	1.352-8.588	0.009
CAD	2.523	1.167-5.456	0.019
TIA	2.829	1.060-7.551	0.038
Low level of HDL	2. 142	1.306-3.514	0.003
Hyperfibrinogenemia	2.904	1.372-6.148	0.005
Increased WBC	0.231	0.143-0.371	0.000
The formation of carotid atheroma	2.676	1.141-6.278	0.024
The formation of common carotid atheroma	3.899	1.771-8.583	0.001

Risk factors	OR (versus female)	95%CI	P
Advanced age	2.573	1.700-3.894	0.000
Cigarette smoking	25.646	10.271-64.027	0.000
Alcohol drinking	38.103	9.265-156.707	0.000
Obesity	0.273	0.147-0.508	0.000
Family history of hypertension	0.653	0.436-0.978	0.039
Family history of stroke	0.525	0.297-0.929	0.027
Kidney disease	2.972	1.103-8.006	0.031
Hypercholesterolemia	0.560	0.392-0.779	0.001
Low HDL level	1.535	1.060-2.223	0.023
Ischemic ECG changes	0.476	0.289-0.784	0.004

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