Stroke in China

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Recent epidemiologic studies confirm that stroke is the most frequent cause of death in the People's Republic of China, with an incidence more than fivefold that of myocardial infarction. Intracerebral hemorrhage causes about one third of all strokes, nearly three times the frequency in North American stroke registries. A marked regional variation in stroke incidence exists, with a threefold higher stroke incidence in northern than in southern Chinese cities, suggesting important environmental or dietary influences. Stroke treatment often involves a combination of modern and traditional herbal medicine; the latter may modify platelet aggregation and blood viscosity. Stroke, particularly intracerebral hemorrhage, is the most frequent and important vascular disorder in China.

Stroke Medical condition where poor blood flow to the brain causes cell death

A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both result in parts of the brain not functioning properly. Signs and symptoms of a stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours it is known as a transient ischemic attack (TIA) or mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent. Long-term complications may include pneumonia or loss of bladder control.

In law, medicine, and statistics, cause of death is an official determination of conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. The cause of death is a specific disease or injury, in contrast to the manner of death which is a small number of categories like "natural", "accident", and "homicide", which have different legal implications.

Myocardial infarction Interruption of blood supply to a part of the heart

Myocardial infarction (MI), also known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat or feeling tired. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.

Contents

China reports more patients with stroke than anywhere else in the world. While there is still a great deal of unknown information, stroke research has been making great progress in recent years, such as in the areas of clinical research, population and genetic epidemiology, brain ischemia/reperfusion exploring, leukoencephalopathy (CADASIL), neural stem cell and stroke, neuroprotective treatment for stroke, clinical therapy test in stroke, rehabilitation and prevention.

China Country in East Asia

China, officially the People's Republic of China (PRC), is a country in East Asia and the world's most populous country, with a population of around 1.404 billion in 2017. Covering approximately 9,600,000 square kilometers (3,700,000 sq mi), it is the third or fourth largest country by total area. Governed by the Communist Party of China, the state exercises jurisdiction over 22 provinces, five autonomous regions, four direct-controlled municipalities, and the special administrative regions of Hong Kong and Macau.

Cities and towns in China have integrated systems for registering and investigating strokes. Chinese researchers have followed closely the international level of stroke treatment with a forward position in neural stem cell. Traditional Chinese drugs have featured effects on neuroprotective treatment for stroke which has also been investigated. Chinese scientists have suggested a new way of dividing neuroprotectors in stroke. The clinical therapy test with urokinase and defibrase for cerebral infarction in China is effective and relatively safe, yet the original papers published by Chinese researchers and clinical effects for patient treatment still need to be improved and updated.

Traditional Chinese medicine Medicine system that purports to have been developed in China over more than 3000 years

Traditional Chinese medicine (TCM) is a branch of traditional medicine that is purported to be based on more than 3,500 years of Chinese medical practice that includes various forms of herbal medicine, acupuncture, cupping therapy, gua sha, massage, bonesetter (die-da), exercise (qigong), and dietary therapy, but recently also influenced by modern Western medicine. TCM is widely used in Sinosphere where it has a long history, and in later years it is also increasingly practiced across the globe. One of the basic tenets of TCM is that the body's vital energy, which is not a scientifically verified phenomenon, is supposedly circulating through channels, called meridians, that are claimed to have branches connected to bodily organs and functions." Concepts of the body and of disease used in TCM reflect its ancient origins and its emphasis on dynamic processes over material structure, similar to European humoral theory.

Epidemiology

Stroke is the second commonest cause of death and leading cause of adult disability in China. [1] Chronic diseases now account for an estimated 80% of deaths and 70% of disability-adjusted life-years lost in China.

The major causes of death in China are vascular disease, cancer, and chronic respiratory disease. [2] Unlike in western countries, cerebrovascular disease predominates; the number of patients who die from stroke is more than three times that from coronary heart disease. [3]

Vascular disease cardiovascular system disease that primarily affects the blood vessels

Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. It is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels, can cause a range of health problems which can be severe or prove fatal.

Cancer group of diseases

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans.

Respiratory disease disease of the respiratory system

Respiratory disease, or lung disease, is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, and the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, acute asthma and lung cancer.

In the past 20 years, China has experienced a rapid economic development. Over time, the proportion of elderly people in the population will likely increase, life expectancies will lengthen, and, as in some other developing countries, the influence of a westernized lifestyle might shift disease patterns towards a profile more similar to that seen in more developed regions, so that the number of strokes will rise. [3]

Economic development is the process by which the economic well-being and quality of life of a nation, region or local community are improved. The term has been used frequently in the 20th and 21st centuries, but the concept has existed in the West for centuries. "Modernization", "Westernization", and especially "industrialization" are other terms often used while discussing economic development.

Life expectancy Statistical measure of how long a person or organism may live, based on factors of their life

Life expectancy, often abbreviated to LEB, is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age and other demographic factors including gender. The most commonly used measure of life expectancy is at birth, which can be defined in two ways. Cohort LEB is the mean length of life of an actual birth cohort and can be computed only for cohorts born many decades ago, so that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year.

Total age-adjusted incidence of first-ever stroke in China is not very different from that in developed countries. Stroke incidence, mortality, and prevalence varies widely among different regions within China, with a noticeable north–south gradient. The proportion of intracerebral haemorrhage was high and reached 55% in one city. [3]

Hypertension is the most important risk factor for stroke. The mass approach combined with a high-risk approach for stroke prevention showed encouraging effects, and various unconventional local therapeutic traditions are commonly used to treat stroke in China. [2]

Several national guidelines on stroke prevention and treatment have been developed. Because of methodological limitations in the epidemiology studies, official government data have been unreliable in terms of making any firm conclusions. There have been calls for urgently needed up-to-date, well-designed, and well-done epidemiological studies and therapeutic trials in China. [1]

Further reading

Stroke Journals

See also

Related Research Articles

Coronary artery disease artery disease characterized by plaque building up along the inner walls of the arteries of the heart resulting in a narrowing of the arteries and a reduced blood supply to the cardiac muscles

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), involves the reduction of blood flow to the heart muscle due to build-up of plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations.

Cerebrovascular disease artery disease that is characterized by dysfunction of the blood vessels supplying the brain

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. Hypertension is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis. Atherosclerosis narrows blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. Narrowed cerebral arteries can lead to ischemic stroke, but continually elevated blood pressure can also cause tearing of vessels, leading to a hemorrhagic stroke.

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

Chronic kidney disease progressive loss in kidney function over a period of months or years

Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of kidney function over a period of months to years. Initially there are generally no symptoms; later, symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications include an increased risk of heart disease, high blood pressure, bone disease, and anemia.

The Framingham Heart Study is a long-term, ongoing cardiovascular cohort study of residents of the city of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of participants. Prior to the study almost nothing was known about the epidemiology of hypertensive or arteriosclerotic cardiovascular disease. Much of the now-common knowledge concerning heart disease, such as the effects of diet, exercise, and common medications such as aspirin, is based on this longitudinal study. It is a project of the National Heart, Lung, and Blood Institute, in collaboration with Boston University. Various health professionals from the hospitals and universities of Greater Boston staff the project.

Sir Richard Peto is Professor of Medical Statistics and Epidemiology at the University of Oxford, England.

Intracerebral hemorrhage Type of intracranial bleeding that occurs within the brain tissue itself

Intracerebral hemorrhage (ICH), also known as cerebral bleed, is a type of intracranial bleed that occurs within the brain tissue or ventricles. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often symptoms get worse over time. Fever is also common. In many cases bleeding is present in both the brain tissue and the ventricles.

Animal models of stroke are procedures undertaken in animals intending to provoke pathophysiological states that are similar to those of human stroke to study basic processes or potential therapeutic interventions in this disease. Aim is the extension of the knowledge on and/or the improvement of medical treatment of human stroke.

A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include arthritis, asthma, cancer, chronic obstructive pulmonary disease, diabetes and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

Hepatitis B is endemic in China. Of the 350 million individuals worldwide infected with the hepatitis B virus (HBV), one-third reside in China. As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.

Moleac is a biopharmaceutical company with headquarters in Biopolis, Singapore. Moleac brings together Asian and Western techniques by identifying medicine discovered in China and developing them into Western mainstream medicine. Moleac's first product, Neuroaid, derived from Traditional Chinese medicine, is focused on brain stroke recovery. It gained market approval in two countries in 2006 and a clinical trial was started in October 2007 with 1100 patients. This trial was completed in August 2012, and some of its details are available at the National Institutes of Health's www.ClinicalTrial.gov site. In this study, NeuroAid was no better than placebo in improving outcomes at 3 months in patients with acute ischemic stroke of intermediate severity.

Sir Rory Edwards Collins FMedSci FRS is a British physician who is Professor of Medicine and Epidemiology at the Clinical Trial Service Unit within the University of Oxford, the head of the Nuffield Department of Population Health and a Fellow of Green Templeton College, Oxford. His work has been in the establishment of large-scale epidemiological studies of the causes, prevention and treatment of heart attacks, other vascular disease, and cancer, while also being closely involved in developing approaches to the combination of results from related studies ("meta-analyses").

Chronic, non-communicable diseases account for an estimated 80% of total deaths and 70% of disability-adjusted life years (DALYs) lost in China. Cardiovascular diseases, chronic respiratory disease, and cancer are the leading causes of both death and of the burden of disease, and exposure to risk factors is high: more than 300 million men smoke cigarettes and 160 million adults are hypertensive, most of whom are not being treated. An obesity epidemic is imminent, with more than 20% of children aged 7–17 years in big cities now overweight or obese. Rates of death from chronic disease in middle-aged people are higher in China than in some high-income countries.

Epidemiology of cancer The study of the extent of cancer spread

The epidemiology of cancer is the study of the factors affecting cancer, as a way to infer possible trends and causes. The study of cancer epidemiology uses epidemiological methods to find the cause of cancer and to identify and develop improved treatments.

Population Impact Measures (PIMs) are biostatistical measures of risk and benefit used in epidemiological and public health research. They are used to describe the impact of health risks and benefits in a population, to inform health policy.

Haroutune Armenian

Haroutune Armenian, is a Lebanon-born Armenian-American academic, physician, doctor of public health (1974), Professor, President of the American University of Armenia, President Emeritus, American University of Armenia. Professor in Residence, UCLA, Fielding School of Public Health.

Simin Liu is an American physician researcher. He holds leadership positions internationally in the research of nutrition, genetics, epidemiology, and environmental and biological influences of complex diseases related to cardiometabolic health in diverse population. His research team has uncovered new mechanisms and risk-factors as well as developed research frameworks for diabetes and cardiovascular diseases. Dr. Liu's laboratory conducts research mainly in the United States, though the group has had research collaborations, teaching, and service activities in six of the Seven Continents.

References

  1. 1 2 Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F. The global stroke initiative. Lancet Neurol 2004; 3: 391-393.
  2. 1 2 Wang LD, Kong LZ, Wu F, Bai YM, Burton R. Preventing chronic diseases in China. Lancet 2005; 366: 1821-1824.
  3. 1 2 3 Wu ZS, Yao CH, Zhao D, et al. Sino-MONICA project A collaborative study on trends and determinants in cardiovascular diseases in China, part I: morbidity and mortality monitoring. Circulation 2001; 103: 462-468.
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