Relationship between Cardiovascular Events and Cerebral Apoplexy in the Elderly

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1 Relationship between Cardiovascular Events and Cerebral Apoplexy in the Elderly Xiaoli Yan 1, Junhui Zhang 1, Lili Chen 1, Shilan Luo 2* ABSTRACT The objective of the paper is to understand the epidemiological characteristics of cardiovascular risk factors of the elderly and to explore its relationship with cerebral apoplexy. Researchers followed patients with cardiovascular disease in a hospital, in which 157 of the patients had had previous cerebral apoplexy history and 1250 of them had not suffered from cerebral apoplexy. Each patient was scored by Framing-ham scale to predict and analyze the risk of cerebral apoplexy in the following 10 years. Single factor analysis and multifactor aggregation rate were used to analyze the risk factors and risk aggregation rate. The results show that the risk of cerebral apoplexy was significantly correlated with sex, diabetes, hypertension, cardiovascular disease, and atrial fibrillation. The total risk factor aggregation rate and the 3 risk factor aggregation rates were different in gender, and the rate of the male was higher than that of the female. Therefore, the paper concludes that gender, hypertension, diabetes, cardiovascular disease and atrial fibrillation are independent risk factors of cerebral apoplexy. Key Words: The Elderly, Cardiovascular Events, Risk Factors, Cerebral Apoplexy DOI Number: /nq NeuroQuantology 2018; 16(6): Introduction Cerebral apoplexy is one of the common diseases and frequently occurring diseases that seriously endanger human health and life. Cardiovascular metabolic risk factors, such as blood pressure and high blood glucose, are not only independent diseases, but also important risk factors for cardiovascular diseases such as cerebral apoplexy and coronary heart disease. At the same time, various cardiovascular metabolic risk factors often occur on one individual, and the synergistic and mutual influence of various risk factors make the risk of cerebral apoplexy increase sharply (Ondiagnosis, 2003). Epidemiological survey shows that the elderly is the major group suffering from cardiovascular metabolic risk factors and is susceptible to cerebral apoplexy. Cerebral apoplexy, also known as stroke or cerebrovascular accident, an acute disease, refers to a neurological deficit syndrome caused by local cerebral circulation disorders, lasting for at least 24hrs. It can be divided into two categories: ischemic cerebral apoplexy and hemorrhagic cerebral apoplexy. Cerebral apoplexy in China has the characteristics of high morbidity, disability rate and mortality rate. Along with heart disease and malignant tumor, they constitute the three leading causes of death. With the improvement of the living standard of our people and the prolongation of the average life span. Cerebral apoplexy has become an important disease that endangers people's health. New stroke cases rises by 2 million people a year. High disability rate is a major cause of long-term physiological dysfunction. Survivors often suffer sequela including hemiplegia, aphasia, dementia and so on(uno et al., 2008). About 75% of stroke patients lose their ability to work to varying Corresponding author: Shilan Luo Address: 1 Department of Health Examination, The First Affiliated Hospital of Chongqing Medical University Chongqing , China; 2 Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Youyi Road No 1, Yuanjiagang, Yuzhong District, Chongqing , China @163.com Relevant conflicts of interest/financial disclosures: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received: 12 May 2018; Accepted: 2 June 2018

2 degrees, and about 40% of them suffer from severe disability. Stroke also brings heavy burden to China's economy and medical treatment. The cost of treating cerebrovascular diseases in the whole country is estimated to be more than 10 billion yuan per year. The mortality rate is high, ranking the first in China. About 1.5 million people die of stroke annually. At present, specific treatment for stroke is in lacking with great limitations in clinical treatment. Therefore, it is of great significance to clarify the risk factors of stroke and to intervene early, which can not only reduce the morbidity and the mortality rate of stroke, but also can urge the early appearance of the turning point. Thus, they are considered as the most effective ways and the most economical methods in stroke treatment. Clinical and epidemiological studies have shown that effective intervention in 2% of the high-risk group of stroke is expected to reduce the incidence of stroke by 30% (simply called "230"), that is, by effective control of the 2% highrisk population of the country, more than 800 thousand new stroke cases can be then reduced each year (Vemmos et al., 2004). The risk factors of stroke can be divided into non-intervention factors and intervention ones. The risk factors for non-intervention include age, sex, race and genetic factors (Gandjour et al., 2004). The risk factors that can be intervened including hypertension, heart disease, diabetes, dyslipidemia, hyperhomocysteinemia, transient ischemic attack (TIA), smoking, alcoholism, obesity, asymptomatic carotid artery stenosis, oral contraceptives, Chlamydia pneumoniae, emotional emergency, anticoagulant therapy which are the main targets of stroke prevention, in which hypertension is the most important target for primary prevention of stroke. In conclusion, modifiable risk factors should be strived to reduce so that toprevent the occurrence of stroke. Therefore, it is of great significance to explore the risk factors of stroke to further reduce the morbidity and mortality rate of stroke. Methods General information A total of 1407 patients with cardiovascular disease were randomly selected from out-patient clinic. Their age range was of them had had previous stroke history, and 1250 had had no history of stroke. Subjects should fulfill the criteria as follows: (1) the subjects suffer from one or more of the diseases including hypertension, diabetes, cardiovascular disease and atrial fibrillation; (2) with complete medical records. Subjects must not have those features including; (3) had previous history of stroke; had not suffered from hypertension, diabetes or cardiovascular disease; (4) without complete medical records. Method 1407 cases were collected to record the history of stroke, name, year of birth, sex, contact, hypertension, diabetes, cardiovascular disease, score of risk assessment of stroke, and risk of stroke in the following 10 years. Statistical analysis SPSS19.0 was used for data statistical analysis, and the measurement data were expressed by mean ± standard deviation (x±s). The risk factors were analyzed by bivariate correlation analysis, univariate ANOVA analysis and multi-factor chisquare test. P<0.05, the difference was statistically significant. Results and discussion Disease factors Cerebral apoplexy is related to gender, diabetes, hypertension, cardiovascular disease and atrial fibrillation, in which hypertension and dyslipidemia are the main causes of the disease(see Table.1). 40 Table 1. Statistics of disease factors in screening populations Gender hypertension Cardiovascular disease Atrial fibrillation diabetes Dyslipidemia Male Total % Female Total % Total Total %

3 Correlation between gender and cerebral apoplexy r=0.585, indicating that gender is significantly associated with cerebral apoplexy. (see Tab.2). Table 2. Correlation between gender and cerebral apoplexy Gender 10-year risk of stroke risk Gender Pearson correlation ** Pearson correlation 0.585** 1 Association of hypertension with 10-year cerebral Patients with hypertension were assigned to 1 while those without is represented by 0. r=0.560, suggesting that hypertension was significantly associated with the risk of 10-year cerebral apoplexy(see Table.3). Table 3. Association of hypertension with 10-year cerebral EH Pearson correlation ** Significant(bilateral) Pearson correlation 0.056* 1 hypertension Significant(bilateral) Relationship between diabetes and 10-year cerebral Patients with diabetes were assigned to 1, and those without diabetes were showed as 0. r=0.262, indicating that diabetes was significantly associated with 10-year cerebral apoplexy risk(see Table.4). Table 4. Relationship between diabetes and 10-year cerebral DM Pearson correlation ** Pearson correlation 0.262** 1 Diabetes Correlation between cardiovascular disease and 10-year cerebral Patients with cardiovascular disease were assigned to 1 and those without were represented by 0. According to SPSS bivariate correlation analysis, r=0.416, suggesting that cardiovascular disease was significantly associated with 10-year cerebral apoplexy risk(see Table.5). Table 5. Correlation between cardiovascular disease and 10-year cerebral DM Pearson correlation 1 ** Cardiovascular diseases Pearson correlation 0.416** 1 Association of atrial fibrillation disease with 10- year cerebral Patients with atrial fibrillation were assigned to 1, and patients without atrial fibrillation were defined as 0. According to the SPSS bivariate correlation analysis, r=0.429, showing significant association between atrial fibrillation disease and 10-year cerebral (see Tab.6). Table 6. Association of atrial fibrillation disease with 10-year cerebral AF 10-year Pearson correlation ** risk of Pearson correlation 0.429** 1 Atrial fibrillation Table 7. Correlation of left ventricular hypertrophy and 10-year cerebral AF Pearson correlation ** Left ventricular hypertrophy Pearson correlation 0.480** 1 Correlation of left ventricular hypertrophy and 10- year cerebral Patients with left ventricular hypertrophy were 1 and those without were defined as 0.According to SPSS bivariate correlation analysis, r=0.480, suggesting significant association between the two(see Tab.7). 41

Table 8. Multivariate analysis Gender n Risk factor aggregation (%) 2(%) 3(%) 4(%) 5(%) Male 673 494 (73.40) 214 (31.80) 179 (26.60) 74 (11.00) 27 (4.01) Female 577 366 (63.43) 199 (34.49) 112 (19.

4 Table 8. Multivariate analysis Gender n Risk factor aggregation (%) 2(%) 3(%) 4(%) 5(%) Male (73.40) 214 (31.80) 179 (26.60) 74 (11.00) 27 (4.01) Female (63.43) 199 (34.49) 112 (19.41) 40 (6.93) 15 (2.60) total (68.80) 413 (33.04) 291 (23.28) 114 (9.12) 42 (3.36) Χ P Multivariate analysis There were multiple risk factors in the study, including sex, diabetes, hypertension, cardiovascular disease, atrial fibrillation and so on. Among these risk factors, 2 or more risk factors were defined as risk factors aggregation. The ratio was compared by Χ 2 test. The results are shown in Table 8. The total risk factor aggregation rate, the three risk factor aggregation rate, and the four risk factor aggregation rates all had P values of <0.05, so the sex ratio was statistically significant, that is, the total risk factor aggregation rate and the three risk factor aggregation. The rate and the rate of 4 risk factor aggregation were significantly higher in males than in females; the clustering rate of 2 risk factors and 5 P values were >0.05, which was not statistically significant, ie there was no difference in male and female sex ratios. Conclusions and outlook This study is a retrospective study to explore the relationship between risk factors and cerebral in the follow-up cardiovascular patients. Studies have shown that gender, diabetes, hypertension, cardiovascular disease and atrial fibrillation are associated with cerebral, which is consistent with the relevant literature (Fox, 2003). Hypertension is a major risk factor for cerebral apoplexy. Hypertension patients, regardless of the other risk factors, cerebrovascular disease accounts for 23% of the main cardiovascular events, which coincides with the fact that cerebral apoplexy is the main outcome of long-term hypertension. Hypertension can cause atherosclerosis, leading to the formation of carotid atherosclerotic plates, resulting in cerebral infarction (see Figure 1), hypertension, carotid atherosclerotic plaques and ischemic cerebrovascular disease. The three are interrelated and have a significant causal relationship. Diabetes is one of the most common cardiovascular risk factors. Related studies have proved that diabetic patients have endothelial dysfunction. The common mechanisms of endothelial dysfunction caused by diabetes include: sustained chronic hyperglycemia which can cause vasoconstriction, increase endothelial cell apoptosis, increase the expression of various cytokines, and promote platelets aggregation, thus causing hypercoagulability, promoting thrombus formation, causing and aggravating vascular endothelial damage; hyperglycemia can promote the nonenzymatic glucosylation of the protein, increase the end products of saccharification; long-term hyperglycemia accelerates the inactivation of nitric oxide, while influence the endotheliocyte synthesis and reduce the NO released by endothelial cells, weakens the dilatation ability of vessels and reduce the arterial compliance (Stergiopoulos et al., 2012). Figure 1. Cerebral infarction The incidence of cardiovascular and cerebrovascular diseases is the result of the interaction of multiple risk factors. A large number of evidence-based medical data show that cardiovascular disease is closely related to the occurrence of cerebral apoplexy (Xu et al., 2008). The cardiovascular risk factors in this study include age, hypertension, diabetes, and dyslipidemia, and these cardiovascular risk factors can cause a certain degree of damage to the structure and function of the arteries, leading to the occurrence of ischemic stroke. Active control should be made on the risk stroke-related 42

5 factors, take the necessary measures in prevention and treatment so that to improve the quality of treatment and life of the patients with ischemic stroke and improve the health of the whole people. Acknowledgements This work was supported by Medical research projects of Chongqing municipal health and Family Planning Commission (2015MSXM025). References Furuta M, Tsunoda K, Arita M, Nanjo K, Sanke T. Endothelium-dependent vasodilation in type II diabetes mellitus. Rinsho byori. The Japanese Journal of Clinical Pathology 2003; 51(11): Fox KM. Efficarcy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomized, double-blind, placebocontrolled, multicentre trial (the EUROPA study). Lancet 2003; 362(9386): Gandjour DA, Lauterbach KW. Review of quality-of-life evaluations in patients with angina pectoris. Pharmaco Economics 1999; 16(2): Ondiagnosis TEC. Report of the expert committee on diagnosis and classification of diabetes mellitus. Diabetes Care 2003; 26(sup1): Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: metaanalysis of randomized controlled trials. Archives of internal medicine 2012; 172(4): Uno H, Ishikawa J, Hoshide S, Kabutoya T, Ishikawa S, Shimada K, Kario K. Effects of strict blood pressure control by a long-acting calcium channel blocker on brain natriuretic peptide and urinary albumin excretion rate in Japanese hypertensive patients. Hypertension Research 2008; 31(5): Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M. U-shaped relationship between mortality and admission blood pressure in atients with cute stroke. Journal of Internal Medicine 2004; 255(2): Xu F, Tse LA, Yin X, Yu IT, Griffiths S. Impact of socioeconomic factors on stroke prevalence among urban and rural residents in Mainland China. BMC Public Health 2008; 8(1):

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