7 results on '"Yang, Zhirong"'
Search Results
2. Statin use is associated with lower risk of dementia in stroke patients: a community-based cohort study with inverse probability weighted marginal structural model analysis.
- Author
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Yang Z, Toh S, Li X, Edwards D, Brayne C, and Mant J
- Subjects
- Cohort Studies, Humans, Models, Structural, Probability, Retrospective Studies, Dementia complications, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Peptic Ulcer complications, Peptic Ulcer drug therapy, Stroke epidemiology, Stroke prevention & control
- Abstract
Current evidence is inconclusive on cognitive benefits or harms of statins among stroke patients, who have high risk of dementia. This observational cohort study investigated the association between statin use and post-stroke dementia using data from the Clinical Practice Research Datalink. Patients without prior dementia who had an incident stroke but received no statins in the preceding year were followed for up to 10 years. We used inverse probability weighted marginal structural models to estimate observational analogues of intention-to-treat (ITT, statin initiation vs. no initiation) and per-protocol (PP, sustained statin use vs. no use) effects on the risk of dementia. To explore potential impact of unmeasured confounding, we examined the risks of coronary heart disease (CHD, positive control outcome), fracture and peptic ulcer (negative control outcomes). In 18,577 statin initiators and 14,613 non-initiators (mean follow-up of 4.2 years), the adjusted hazard ratio (aHR) for dementia was 0.70 (95% confidence interval [CI] 0.64-0.75) in ITT analysis and 0.55 (95% CI 0.50-0.62) in PP analysis. The corresponding aHR
ITT and aHRPP were 0.87 (95% CI 0.79-0.95) and 0.70 (95% CI 0.62-0.80) for CHD, 1.03 (95% CI 0.82-1.29) and 1.09 (95% CI 0.77-1.54) for peptic ulcer, and 0.88 (95% CI 0.80-0.96) and 0.86 (95% CI 0.75-0.98) for fracture. Statin initiation after stroke was associated with lower risk of dementia, with a potentially greater benefit in patients who persisted with statins over time. The observed association of statin use with post-stroke dementia may in part be overestimated due to unmeasured confounding shared with the association between statin use and fracture., (© 2022. The Author(s).)- Published
- 2022
- Full Text
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3. Association of Prior Atherosclerotic Cardiovascular Disease with Dementia After Stroke: A Retrospective Cohort Study.
- Author
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Yang Z, Edwards D, Burgess S, Brayne C, and Mant J
- Subjects
- Adult, Aged, Aged, 80 and over, Atherosclerosis diagnosis, Cardiovascular Diseases diagnosis, Cohort Studies, Dementia diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Stroke diagnosis, Atherosclerosis epidemiology, Cardiovascular Diseases epidemiology, Dementia epidemiology, Stroke epidemiology
- Abstract
Background: Prior atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD) and peripheral artery disease (PAD), are common among patients with stroke, a known risk factor for dementia. However, whether these conditions further increase the risk of post-stroke dementia remains uncertain., Objective: To examine whether prior ASCVD is associated with increased risk of dementia among stroke patients., Methods: A retrospective cohort study was conducted using the Clinical Practice Research Datalink with linkage to hospital data. Patients with first-ever stroke between 2006 and 2017 were followed up to 10 years. We used multi-variable Cox regression models to examine the associations of prior ASCVD with dementia and the impact of prior ASCVD onset and duration., Results: Among 63,959 patients, 7,265 cases (11.4%) developed post-stroke dementia during a median of 3.6-year follow-up. The hazard ratio (HR) of dementia adjusted for demographics and lifestyle was 1.18 (95% CI: 1.12-1.25) for ASCVD, 1.16 (1.10-1.23) for CHD, and 1.25 (1.13-1.37) for PAD. The HRs additionally adjusted for multimorbidity and medications were 1.07 (1.00-1.13), 1.04 (0.98-1.11), and 1.11 (1.00-1.22), respectively. Based on the fully adjusted estimates, there was no linear relationship between the age of ASCVD onset and post-stroke dementia (all p-trend >0.05). The adjusted risk of dementia was not increased with the duration of pre-stroke ASCVD (all p-trend >0.05)., Conclusion: Stroke patients with prior ASCVD are more likely to develop subsequent dementia. After full adjustment for confounding, however, the risk of post-stroke dementia is attenuated, with only a slight increase with prior ASCVD.
- Published
- 2020
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4. Association of blood lipids, atherosclerosis and statin use with dementia and cognitive impairment after stroke: A systematic review and meta-analysis.
- Author
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Yang Z, Wang H, Edwards D, Ding C, Yan L, Brayne C, and Mant J
- Subjects
- Aged, Aged, 80 and over, Atherosclerosis, Cognitive Dysfunction etiology, Dementia etiology, Female, Humans, Male, Middle Aged, Cognitive Dysfunction prevention & control, Dementia prevention & control, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Lipids blood, Stroke complications
- Abstract
Background: Trial and observational evidence is conflicting in terms of the association of blood lipids, atherosclerosis and statin use with dementia and cognitive impairment in the general population. It is uncertain whether the associations occur in stroke patients, who are at known higher risk of cognitive decline. This systematic review was to synthesize the evidence for these associations among stroke patients., Methods: MEDLINE, EMBASE, the Cochrane Library and trial registries were searched. We included randomized controlled trials (RCTs) or observational cohort studies conducted among patients with stroke and reported on the association of blood lipids, atherosclerosis or statin use with dementia or cognitive impairment. Meta-analysis was conducted separately for crude and maximally adjusted odds ratios (ORs) and hazard ratios (HRs)., Results: Of 18,026 records retrieved, 56 studies (one RCT and 55 cohort studies) comprising 38,423 stroke patients were included. For coronary heart disease, the pooled OR of dementia and cognitive impairment was 1.32 (95%CI 1.10-1.58, n = 15 studies, I
2 = 0%) and 1.23 (95%CI 0.99-1.54, n = 14, I2 = 26.9%), respectively. Peripheral artery disease was associated with dementia (OR 3.59, 95%CI 1.47-8.76, n = 2, I2 = 0%) and cognitive impairment (OR 2.70, 95%CI 1.09-6.69, n = 1). For carotid stenosis, the pooled OR of dementia and cognitive impairment was 2.67 (95%CI 0.83-8.62, n = 3, I2 = 77.9%) and 3.34 (95%CI 0.79-14.1, n = 4, I2 = 96.6%), respectively. For post-stroke statin use, the pooled OR of dementia and cognitive impairment was 0.89 (95%CI 0.65-1.21, n = 1) and 0.56 (95%CI 0.46-0.69, n = 3, I2 = 0%), respectively. No association was observed for hypercholesterolemia. These results were mostly consistent with adjusted ORs or HRs, which were reported from limited evidence., Conclusion: Atherosclerosis was associated with an increased risk of post-stroke dementia. Post-stroke statin use was associated with decreased risk of cognitive impairment. To confirm whether or not statins confer advantages in the post-stroke population in terms of preventing cognitive decline over and above their known effectiveness in reducing risk of further vascular events, further stroke trials including cognitive assessment and observational analyses adjusted for key confounders, focusing on key subgroups or statin use patterns are required., (Copyright © 2019 Elsevier B.V. All rights reserved.)- Published
- 2020
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5. Association of blood lipids, atherosclerosis and statin use with dementia after stroke
- Author
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Yang, Zhirong, Mant, Jonathan, Brayne, Carol, and Burgess, Stephen
- Subjects
616.8 ,Stroke ,Dementia ,Blood lipids ,Atherosclerosis ,Statin use - Abstract
Background: Stroke patients are at high risk of dementia. While cardiovascular comorbidities, such as hyperlipidaemia and atherosclerosis, have been linked to dementia in the general population, it is unclear whether the associations persist in stroke patients, who usually suffer more cardiovascular comorbidities. Statins have been recommended for secondary prevention in stroke patients, but it is unclear whether they have any cognitive effects separate from reducing risk of vascular events. Aim: To triangulate the potential roles of major blood lipids, atherosclerosis and statins in the development of dementia after stroke. Methods: First, I conducted a systematic review to identify the gaps in previous studies on the association of the three factors with post-stroke dementia. In response to the limitations of the previous studies, I conducted three cohort studies using the Clinical Practice Research Datalink (CPRD) for blood lipids, atherosclerosis and statin use, respectively. Given the limitations in the CPRD data, I further used UK Biobank to explore whether the CPRD results could be replicated using similar analytic strategies. Results: My systematic review suggested that hyperlipidaemia was not associated with post-stroke dementia, atherosclerosis was associated with increased risk of post-stroke dementia and post-stroke statin use may reduce the risk. Only one small-scale trial was available, and all other studies were observational with key methodological limitations. My CPRD study on major blood lipids showed that low-density lipoprotein (LDL) cholesterol was associated with increased risk of post-stroke dementia (adjusted hazard ratio [aHR] 1.29, 95% confidence interval [CI] 1.14-1.47, per one log-mmol/L increase), with a linear increasing trend in the risk across quintiles and different guideline targets of LDL cholesterol (all P-trend <0.001). Conversely, triglycerides were associated with decreased risk of dementia (aHR 0.79, 95% CI 0.70-0.90, per one log-mmol/L increase), with a linear decreasing trend in the risk across quintiles of triglycerides (P-trend <0.001). No significant association was found for high-density lipoprotein (HDL) cholesterol. My CPRD study on atherosclerosis suggested that stroke patients with prior atherosclerotic cardiovascular disease (ASCVD) were more likely to develop subsequent dementia (aHR 1.18, 95% CI 1.12-1.25). After full adjustment for potential baseline confounding, however, the risk of post-stroke dementia is attenuated (aHR 1.07, 95% CI 1.00-1.13), with no linear relationship between the age of ASCVD onset or duration of pre-stroke ASCVD and post-stroke dementia (all P-trend >0.05). My CPRD study on statin use found that statin initiation within the first three months after stroke was associated with lower risk of dementia (aHR 0.70, 95% CI 0.64-0.75). After accounting for non-persistence, the risk was further decreased (aHR 0.55, 95% CI 0.50-0.62). My UK Biobank study supported the CPRD findings. The observed associations tended to be stronger than from the CPRD, while mostly not statistically significant due to low incidence of post-stroke dementia in the younger volunteer population in UK Biobank. Conclusions: Blood lipids may affect the risk of post-stroke dementia in different ways, with higher risk associated with LDL cholesterol, lower risk associated with triglycerides, and no association with HDL cholesterol. Stroke patients with prior ASCVD were more likely to develop subsequent dementia but the direct impact of pre-stroke atherosclerosis on the occurrence of post-stroke dementia may not be substantial. Statins have the potential to reduce the risk of dementia over and above future vascular events. Further trials and more real-world studies are needed to confirm the potential benefits of statins, to determine the optimal target of LDL cholesterol and to clarify the roles of triglycerides in the prevention of dementia.
- Published
- 2020
6. Association of major blood lipids with post-stroke dementia: A community-based cohort study
- Author
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Yang, Zhirong, Edwards, Duncan, Burgess, Stephen, Brayne, Carol, Mant, Jonathan, Yang, Zhirong [0000-0002-1562-0603], Apollo - University of Cambridge Repository, Burgess, Stephen [0000-0001-5365-8760], and Brayne, Carol [0000-0001-5307-663X]
- Subjects
Cohort Studies ,HDL cholesterol ,Risk Factors ,LDL cholesterol ,Humans ,lipids (amino acids, peptides, and proteins) ,Dementia ,stroke ,triglycerides ,Lipids ,Retrospective Studies - Abstract
BACKGROUND AND PURPOSE: The roles of blood low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides in the development of post-stroke dementia remain uncertain. This study was to investigate their potential associations. METHODS: A retrospective cohort study was conducted using the Clinical Practice Research Datalink. Patients with first-ever stroke but no prior dementia were followed up for 10 years. Cox regression was used to examine the association of baseline LDL-C, HDL-C and triglycerides with post-stroke dementia. RESULTS: Amongst 63,959 stroke patients, 15,879 had complete baseline data and were included in our main analysis. 10.8% developed dementia during a median of 4.6 years of follow-up. The adjusted hazard ratio of dementia for LDL-C (per log mmol/l increase) was 1.29 (95% confidence interval [CI] 1.14-1.47), with a linear increasing trend (p trend
- Published
- 2022
7. Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study.
- Author
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Yang, Zhirong, Edwards, Duncan, Massou, Efthalia, Saunders, Catherine L, Brayne, Carol, and Mant, Jonathan
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TRANSIENT ischemic attack ,COHORT analysis ,STROKE ,POISSON regression ,CARDIOVASCULAR diseases risk factors ,THERAPEUTICS - Abstract
Background: Trial evidence supports statin use after ischemic stroke and recent American, European and British guidelines recommend high-intensity statins for this indication. Limited data are available describing current statin use among these patients in unselected settings. We conducted a cohort study to examine secular trends and factors associated with statin use and dose following ischemic stroke. Methods: A retrospective cohort study of patients with first ischemic stroke between 2000 and 2014 was conducted using the Clinical Practice Research Datalink (CPRD). Proportions of statin users and high-intensity statin users within 2 years after stroke were estimated for each calendar year. We used Cox regression models to explore potential factors associated with statin use and Poisson regression models to calculate risk ratios for the use of a high-intensity statin. Results: A total of 80,442 patients with first stroke were analyzed. The proportion using statins within 2 years after stroke increased from 25% in 2000 to 70% in 2006 and remained at about 75% through 2014. Among post-stroke statin users, high-intensity use accounted for approximately 15% between 2004 and 2011 and then increased to almost 35% in 2014. Older patients (aged ≥75 years), younger patients (<45 years), patients with no prior statin treatment, dementia, underweight, or absence of cardiovascular factors (coronary heart disease, smoking, obesity, diabetes, hypertension, or transient ischemic attack) were less likely to use statins and less likely to receive a high-intensity statin. Conclusion: There has been an increase over time in both statin use and dose, but many patients with ischemic stroke continue to be under-treated. Clinical trials and policy interventions to improve appropriate post-stroke statin use should focus on younger and older patients, patients with no pre-stroke statin treatment, and patients without additional cardiovascular risk factors. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
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