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Brain and heart comorbidity is one of the major public health problems in China, which seriously threatens national health. After many years of exploration, the concept of "synchronous treatment for brain and heart" has become more and more accepted. This article summarizes the pathophysiological mechanism of brain-heart interaction, the clinical and research practice of the theory of "synchronous treatment for brain and heart", and its future development direction, and jointly help the diagnosis and treatment of brain and heart comorbidity. [ABSTRACT FROM AUTHOR]

Objective Bilateral medial medullary infarction (MMI) is prone to misdiagnosis. This study summarizes the clinical characteristics of MMI, in order to provide reference to clinicians. Methods and Results The clinical data of the 3 patients with acute bilateral MMI treated in Ruijin Hospital North Campus affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to January 2022 were collected. All 3 patients had acute onset, one case had acute myelitis-like manifestations (rapidly progressive quadriplegia), one case had intractable hiccup, and the other one had unilateral limb numbness and fatigue as the first manifestation, accompanied by hypoglossal palsy. The head MRI showed acute bilateral MMI (one case without acute lesions on early MRI). Two cases were misdiagnosed because of either presenting lower motor neuron damage signs or having atypical symptoms. All patients improved after antithrombotic therapy for acute cerebral infarction. Conclusions The clinical manifestations of acute bilateral MMI are diverse, and it's easy to be misdiagnosed in the early stage. The diagnosis is mainly based on clinical manifestations and head MRI, which requires early recognition and timely antithrombotic treatment for acute cerebral infarction. The main distinguishing points are whether there are risk factors for stroke, upper motor neuron damage signs, and the treatment was effective. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of cerebral vascular disease treated by transplantations of the short-segment radial artery (RA) using the internal maxillary artery (IMA) as the feeding artery. Methods and Results The clinical data of 5 cases with cerebral vascular disease treated by IMA-RA-cerebral artery bypass (IMAB) from August 2018 to April 2021 in the First Hospital of China Medical University were retrospectively analyzed. There were 3 cases of dissecting aneurysms [one case of right middle cerebral artery (MCA) M2 segment, one case of left MCA M1 segment, one case of right posterior cerebral artery (PCA) P2 segment], and 2 cases of vertebral basilar artery ischemia [one case of bilateral vertebral artery (VA) occlusion, one case of severe basilar artery (BA) stenosis]. Two patients underwent the IMA-RA-M2 bypass, and 3 patients underwent the IMA-RA-P2 bypass. Intraoperative indocyanine green angiography (ICGA) and Doppler ultrasonography confirmed patency of the RA in 4 cases and occluded RA in one case (the anastomosis of IMA-RA was opened, the intima of IMA was dissociated from the media, and RA was unobstructed after resuture). One patient developed basal ganglia infarction after the surgery. The RA blood flow was measured by ultrasound 123, 51, 77, 69 ml/min in 4 patients at one week after the surgery. One patient had a RA blood flow of 89 ml/min on 6 months after the surgery (69 ml/min on one week after the surgery), and one patient had a RA blood flow of 66 ml/min 26 months after the surgery (51 ml/min on one week after the surgery). One patient with dissociated M1 segment aneurysm with ischemic onset developed ischemic infarction in basal ganglia region after open aneurysm and bypass, and modified Rankin Scale (mRS) increased by one point on one week after surgery. mRS score of 3 patients decreased by one point and one patient had no change; after 8-40 months of follow-up, all patients recovered well, with mRS score of 0 in 2 cases, one in 2 cases, and 2 in one case. Conclusions The IMAB can provide moderate flow of blood supply to brain tissue, and the RA has good patency and stable flow during long-term follow-up. This operation can be used to treat patients with cerebral vascular disease of choosy and reduce the risk of cerebral ischemia effectively. [ABSTRACT FROM AUTHOR]

Background: This is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China, based on a nationally representative sample., Methods: Patients were chosen from 20 geographically diverse sites from the nationally representative database China National Stroke Registry-III (CNSR-III). The inclusion criteria were surviving patients who were hospitalised with first-ever ischaemic stroke from February 2017 to February 2018 (the index event); aged 18-80 during the index event; no history of other stroke types. The primary endpoints were direct medical costs, direct non-medical costs, indirect costs and total cost (ie, the sum of all cost components). Patient characteristics and clinical data were extracted from CNSR-III. Stroke-related in-hospital direct medical costs were collected from hospital electronic medical records. The patient survey collected data related to out-of-hospital direct medical costs, direct non-medical costs and indirect costs. The secondary objective was to explore clinical factors associated with cost outcomes through univariate analysis and multiple regression., Results: The study enrolled 520 patients. The total cost was 57 567.48 CNY, with 26 612.67 CNY direct medical costs, 2 787.56 CNY direct non-medical costs and 28 167.25 CNY indirect costs. Univariate analysis showed that longer lengths of stay during the index event, higher National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were associated with higher costs in all categories. Conversely, EuroQol 5 Dimension utility scores were associated with decreased costs except direct non-medical costs. Multiple regressions showed that higher admission NIHSS scores were independently associated with higher direct medical costs, indirect costs and total cost. Higher 3-month utilities were associated with lower total cost., Conclusion: This real-world study showed substantial 1-year economic burden following first-ever ischaemic stroke in China, and that indirect costs are a non-negligible driver of costs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Multiple factors play important roles in the occurrence and prognosis of stroke. However, the roles of monogenic variants in all-cause ischaemic stroke have not been systematically investigated. We aim to identify underdiagnosed monogenic stroke in an adult ischaemic stroke/transient ischaemic attack (TIA) cohort (the Third China National Stroke Registry, CNSR-III)., Methods: Targeted next-generation sequencing for 181 genes associated with stroke was conducted on DNA samples from 10 428 patients recruited through CNSR-III. The genetic and clinical data from electronic health records (EHRs) were reviewed for completion of the diagnostic process. We assessed the percentages of individuals with pathogenic or likely pathogenic (P/LP) variants, and the diagnostic yield of pathogenic variants in known monogenic disease genes with associated phenotypes., Results: In total, 1953 individuals harboured at least one P/LP variant out of 10 428 patients. Then, 792 (7.6%) individuals (comprising 759 individuals harbouring one P/LP variant in one gene, 29 individuals harbouring two or more P/LP variants in different genes and 4 individuals with two P/LP variants in ABCC6 ) were predicted to be at risk for one or more monogenic diseases based on the inheritance pattern. Finally, 230 of 792 individuals manifested a clinical phenotype in the EHR data to support the diagnosis of stroke with a monogenic cause. The most diagnosed Mendelian cause of stroke in the cohort was cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. There were no relationships between age or family history and the incidence of first symptomatic monogenic stroke in patients., Conclusion: The rate of monogenic cause of stroke was 2.2% after reviewing the clinical phenotype. Possible reasons that Mendelian causes of stroke may be missed in adult patients who had an ischaemic stroke/TIA include a late onset of stroke symptoms, combination with common vascular risks and the absence of a prominent family history., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although bypass surgery is an effective treatment for moyamoya vasculopathy (MMV), the incidence of postoperative complications is still high. This study aims to introduce a novel evaluating system based on individualised pathophysiology of MMV, and to assess its clinical significance., Methods: This multicentre, prospective study enrolled adult patients with MMV from Huashan Hospital, Fudan University and National Center for Neurological Disorders, China between March 2021 and February 2022. Multimodal neuroimages containing structural and functional information were used to evaluate personalised disease severity and fused to localise the surgical field, avoid invalid regions and propose alternative recipient arteries. The recipient artery was further selected intraoperatively by assessing regional haemodynamic and electrophysiological information. The preanastomosis and postanastomosis data were compared with assist with the postoperative management. Patients who received such tailored revascularisations were included in the novel group and the others were included in the traditional group. The 30-day surgical outcomes and intermediate long-term follow-up were compared., Results: Totally 375 patients (145 patients in the novel group and 230 patients in the traditional group) were included. The overall complication rate was significantly lower in the novel group (p˂0.001). In detail, both the rates of postoperative infarction (p=0.009) and hyperperfusion syndrome (p=0.010) were significantly lower. The functional outcomes trended to be more favourable in the novel group, though not significantly (p=0.260). Notably, the proportion of good functional status was higher in the novel group (p=0.009). Interestingly, the preoperative statuses of perfusion and metabolism around the bypass area were significantly correlated with the occurrence of postoperative complications (P˂0.0001)., Conclusions: This novel evaluating system helps to identify appropriate surgical field and recipient arteries during bypass surgery for MMV to achieve better haemodynamic remodelling and pathophysiological improvement, which results in more favourable clinical outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective To analyze the distribution of ApoE and SLCO1B1 genetic polymorphisms of patients with cardiovascular and cerebrovascular diseases in Han nationality of Hebei region. Methods Patients with cardiovascular and cerebrovascular diseases admitted to our hospital corresponding department from June 2019 to October 2020 were selected. The polymorphisms of ApoE and SLCO1B1 genes in 4193 patients with cardiovascular and cerebrovascular diseases were detected qualitatively by polymerase chain reaction (PCR)- fluorescence probe technique, to analyze the distribution characteristics of polymorphism and compare the genotype distribution difference between male and female. Results The observed mutation frequencies of ApoE and SLCO1B1 gene polymorphism of Han nationality in Hebei region were consistent with the Hardy-Weinberg genetic balance. Moreover, there was no significant difference in the distribution of ApoE gene polymorphism at 388T>C and 526C>T and SLCO1B1 gene polymorphism at 388A>G and 521T>C between men and women (P >0.05). Among the six genotypes of ApoE in Han nationality people, genotype ε3/ε3 accounted for 68.57% (2875/4193), followed by ε3/ε4 (15.48%, 649/4193), ε2/ε3 (12.81%, 537/4193), ε2/ε4 (1.69%, 71/4193), ε4/ε4 (0.98%, 41/4193), and ε2/ε2 (0.48%, 20/4193). There was no significant difference in the distribution of ApoE gene phenotypes between male and female (P = 0.223). Among the seven genotypes of SLCO1B1 gene, *1h/*1h and *1a/*1b accounted for the largest proportion 39.57% (1659/4193) and 31.05% (1302/4193), while other genotypes *1h/*15, *1a/*1a, *1a/*15, *15/*15 and *1a/*5 accounted for 14.31% (600/4193), 7.20% (302/4193), 6.42% (269/4193), 1.43% (60/4193) and 0.02% (1/4193) respectively. There was no significant difference in the distribution of SLCO1B1 gene phenotypes between male and female (P = 0.078). Conclusions The distribution of ApoE and SLCO1B1 gene polymorphisms is different in patients with cardiovascular and cerebrovascular diseases in Han nationality of Hebei region, and the distribution of ApoE and SLCO1B1 genetic polymorphisms is independent of gender. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated., Methods: We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention's Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models., Results: In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/10 5 ) and rural areas (123.0/10 5 ) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/10 5 ), the western region had a slightly lower mortality (123.5/10 5 ), and the eastern region had the lowest mortality (97.3/10 5 ). The age-specific mortality showed an accelerated upward trend from aged 55-59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02-3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030., Conclusion: The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control., (Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

During the period of Twelfth Five - Year Plan for National Economic and Social Development, clinical study on cerebrovascular disease in China has made great progress. The results of antiplatelet treatment in patients with high - risk non - disabling cerebrovascular events, standardized secondary prevention of ischemic stroke, epidemiological survey of asymptomatic ischemic stroke in community population, cross-sectional survey on traditional Chinese medicine for treating ischemic stroke, the impact of blood glucose on prognosis of acute ischemic stroke, ischemic stroke combined with chronic kidney disease and cerebral microbleeds, biomarkers of ischemic cerebrovascular diseases, mitochondrial encephalomyopathy with lactic academia and stroke - like episodes (MELAS) and encephalatrophy, perioperative management of blood pressure in intracerebral hemorrhage, vascular structural abnormality - related intracerebral hemorrhage score (VSARICHS), and epidemiological survey of cerebrovascular disease in China have been published in many important journals. This paper reviewed these studies and made a brief introduction. [ABSTRACT FROM AUTHOR]

Background: Increased physical activity is associated with a reduced risk of cardiovascular disease, but outdoor physical activity can be accompanied by increased inhalation of fine particulate matter (PM 2·5 ). The extent to which long-term exposure to PM 2·5 can offset the cardiovascular benefits of physical activity is unknown. We aimed to evaluate whether the associations between active commuting or farming activity and incident risks of cerebrovascular disease and ischaemic heart disease were consistent between populations with different ambient PM 2·5 exposures., Methods: We did a prospective cohort study using data from people aged 30-79 years without cardiovascular disease at baseline from the China Kadoorie Biobank (CKB). Active commuting and farming activity were assessed at baseline using questionnaires. A high-resolution (1 × 1 km) satellite-based model was used to estimate annual average PM 2·5 exposure during the study period. Participants were stratified according to PM 2·5 exposure (54 μg/m 3 or greater vs less than 54 μg/m 3 ). Hazard ratios (HRs) and 95% CIs for incident cerebrovascular disease and ischaemic heart disease by active commuting and farming activity were estimated using Cox proportional hazard models. Effect modifications by PM 2·5 exposure were tested by likelihood ratio tests. Analyses were restricted to the period from Jan 1, 2005, to Dec 31, 2017., Findings: Between June 25, 2004, and July 15, 2008, 512 725 people were enrolled in the CKB cohort. 322 399 eligible participants completed the baseline survey and were included in the analysis of active commuting (118 274 non-farmers and 204 125 farmers). Among 204 125 farmers, 2985 reported no farming time and 201 140 were included in the farming activity analysis. During a median follow-up of 11 years, 39 514 cerebrovascular disease cases and 22 313 ischaemic heart disease cases were newly identified. Among non-farmers with exposure to annual average PM 2·5 concentrations of less than 54 μg/m 3 , increased active commuting was associated with lower risks of cerebrovascular disease (highest active commuting vs lowest active commuting HR 0·70, 95% CI 0·65-0·76) and ischaemic heart disease (0·60, 0·54-0·66). However, among non-farmers with exposure to annual average PM 2·5 concentrations of 54 μg/m 3 or greater, there was no association between active commuting and cerebrovascular disease or ischaemic heart disease. Among farmers with exposure to annual average PM 2·5 concentrations of less than 54 μg/m 3 , increased active commuting (highest active commuting vs lowest active commuting HR 0·77, 95% CI 0·63-0·93) and increased farming activity (highest activity vs lowest activity HR 0·85, 95% CI 0·79-0·92) were both associated with a lower cerebrovascular disease risk. However, among farmers with exposure to annual average PM 2·5 concentrations of 54 μg/m 3 or greater, increases in active commuting (highest active commuting vs lowest active commuting HR 1·12, 95% CI 1·05-1·19) and farming activity (highest activity vs lowest activity HR 1·18, 95% CI 1·09-1·28) were associated with an elevated cerebrovascular disease risk. The above associations differed significantly between PM 2·5 strata (all interaction p values <0·0001)., Interpretation: For participants with long-term exposure to higher ambient PM 2·5 concentrations, the cardiovascular benefits of active commuting and farming activity were significantly attenuated. Higher levels of active commuting and farming activity even increased the cerebrovascular disease risk among farmers with exposure to annual average PM 2·5 concentrations of 54 μg/m 3 or greater., Funding: National Natural Science Foundation of China, National Key Research and Development Program of China, Kadoorie Charitable Foundation, UK Wellcome Trust., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Intracerebral haemorrhage (ICH) is the most devastating form of stroke causing high morbidity and mortality. We aimed to develop a novel clinical score incorporating multisystem markers to predict functional dependence at 90 days after ICH., Methods: We analysed data from Chinese Cerebral Hemorrhage: Mechanism and Intervention study. Multivariable logistic regression analysis was used to identify the factors associated with 90-day functional dependency (the modified Rankin Scale ≥3) after ICH and develop the ADVISING scoring system. To test the scoring system, a total of 2111 patients from Hubei province were included as the training cohort, and 733 patients from other three provinces in China were included as an external validation cohort., Results: We found nine variables to be significantly associated with functional dependency and included in the ADVISING score system: age, deep location of haematoma, volume of haematoma, National Institutes of Health Stroke Scale, aspartate transaminase, international normalised ratio, neutrophil-lymphocyte ratio, fasting blood glucose and glomerular filtration rate. Individuals were divided into 12 different categories by using these nine potential predictors. The proportion of patients who were functionally dependent increased with higher ADVISING scores, which showed good discrimination and calibration in both the training cohort (C-statistic, 0.866; p value of Hosmer-Lemeshow test, 0.195) and validation cohort (C-statistic, 0.884; p value of Hosmer-Lemeshow test, 0.853). The ADVISING score also showed better discriminative performance compared with the other five existing ICH scores (p<0.001)., Conclusions: ADVISING score is a reliable tool to predict functional dependency at 90 days after ICH., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Increasing research suggested that green spaces are associated with many health benefits, but evidence for the quantitative relationship between green spaces and mortality attributable to particulate matter with an aerodynamic diameter of 2.5 μm or less (PM 2.5 ) is limited. We collected disease-specific mortality and PM 2.5 data for a period of 4 years (2015-2018) along with green space data for an 8-year duration (2010-2017) in 31 provincial-level administrative regions of China. First, this study used the Integrated Exposure-Response model to estimate the mortality of four diseases attributable to PM 2.5 , including chronic obstructive pulmonary diseases (COPD), lung cancer (LC), ischemic heart disease (IHD), and cerebrovascular disease (CBVD). Then we performed linear regression and mixed-effects model to investigate the counteracting effect of green spaces on death caused by PM 2.5 exposure. The differences in impacts among the Eastern, Central, and Western regions were explored using stratified analysis. The most significant results from linear regression analysis indicated that per 100 km 2 of green spaces increase, there was a decreased total mortality (10 -5 ) (COPD, LC, IHD, and CBVD) attributable to PM 2.5 by - 4.012 [95% confidence interval (CI): - 5.535, - 2.488], while the reduction by mixed-linear regression analysis was - 2.702/10 5 (95% CI =  - 3.645, - 1.759). Of all hysteresis analyses, the effect estimates (β) at lag3 and lag4 were the largest. The effect of green spaces was more advantageous when targeting CBVD and the Eastern region. We found a negative correlation between green space exposure and mortality attributable to PM 2.5 , which can provide further support for city planners, government personnel, and others to build a healthier city and achieve national health goals., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Associations between red meat consumption and cardio-cerebrovascular diseases (CCVDs) are mostly studied in Western populations but not in Chinese or elderly. This prospective study investigated adults ≥65 years from the China Kadoorie Biobank (CKB). Associations between red meat consumption and CCVD, ischemic stroke/transient ischemic attack (TIA), CCVD mortality, and all-cause mortality were determined by Cox regression. A total of 59,980 participants were analyzed, 14,715 (24.53%) of whom ate red meat daily, 9,843 (16.41%) ate red meat 4-6 days/week, 23,472 (39.13%) ate red meat 1-3 days/week, and 11,950 (19.92%) ate red meat less than 1 day/week. Average amount of red meat usual consumption was 38 g/day. After adjustment, per 50 g/day higher red meat consumption at baseline was significantly associated with increased incident CCVD (aHR = 1.10) among high-income subjects (≥ 10,000 RMB) and urban residents (aHR = 1.12). Per 50 g/day higher baseline red meat consumption was significantly associated with increased ischemic stroke/TIA in urban residents (aHR = 1.08) but decreased risk in rural residents (aHR = 0.84). Higher baseline red meat consumption was associated with lower CCVD mortality in the poorest (aHR = 0.78) and rural residents (aHR = 0.72) and lower all-cause mortality in the poorest (aHR = 0.82) and rural residents (aHR = 0.80). In general, among older adults in China, higher red meat intake independently predicted increased CCVD among urban and high-income individuals but not poor ones. Higher red meat intake appears to be protective against mortality in rural and low-income subjects. Socioeconomic status is a crucial modifying factor on the association between red meat consumption and adverse cardiovascular outcomes in China.

Background: Integrating the management of dementia into primary healthcare is a cost-effective way to reduce the burden of dementia but the clinical epidemiology of dementia in primary healthcare settings remains unclear. This study investigated the prevalence and correlates of suspected dementia in Chinese older adults receiving primary healthcare., Methods: In this multicenter cross-sectional survey, a total of 773 older adults (≥65 years) were consecutively recruited from seven urban and six rural primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the Brief Community Screening Instrument for Dementia (BCSI-D). Participants with suspected dementia were those who were screened positive on the BCSI-D., Results: The prevalence of suspected dementia in older primary healthcare adults was 26.8%. Factors significantly associated with suspected dementia were female sex (OR = 1.95, P < 0.001), age-group of 75+ (OR = 1.68, P = 0.004), poor financial status (OR = 4.79, P < 0.001), rural residence (OR = 1.47, P = 0.032), no regular physical exercise (OR = 1.74, P = 0.002), and stroke and other cerebrovascular diseases (OR = 1.97, P = 0.015)., Conclusions: Chinese older adults receiving primary healthcare are at high risk of suspected dementia. Screening and intervention efforts for dementia in primary healthcare settings may be more useful to target older adults who are women, are 75 years and above, have poor economic status, are rural residents, have no exercise habit, and suffer from cerebrovascular diseases., Competing Interests: 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., (Copyright © 2022 Wang, Fei, Xu, Deng and Zhong.)

Objective: To delineate the mortality trends of malignant tumors, heart disease and cerebrovascular disease in China. Methods: The crude mortality from 2003 to 2019 was derived from the China Health Statistical Yearbook, and the mortality rates were analyzed through joinpoint regression supplemented by descriptive statistics and χ2 tests. Results: The fitting model of age-standardized mortality due to malignant tumors showed three joinpoints. The APCs from 2003 to 2005, 2005-2008, 2008-2012 and 2012-2019 were -11.00%, 9.63%, -4.67% and -1.40%, respectively, and the AAPC was -1.54%. The mortality rate of cerebrovascular disease consistently decreased (APC = AAPC = -0.98%). In the subgroup analyses, significant differences were observed between sexes and regions. The mortality rate of heart disease among rural females exhibited an upward trend (APC = AAPC = 2.33%). Older adults aged over 75 years had the highest mortality rates and the most drastic change. Conclusion: The three diseases had variable change trends. The government should focus more on policies that promote the equalization of basic public health services. Continuous education on heart disease, which includes not only beneficial behaviors but also knowledge of first aid, should be strengthened for rural females., Competing Interests: 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., (Copyright © 2022 Zhang, Hu, Liu, Zhang, Zhou, Li, Zhu, Qi and Wu.)

Background: Stroke after acute coronary syndrome (ACS) can be devastating. It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage (ICH) are associated with different choices of P2Y12 inhibitors (potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel). Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians, data on Chinese patients are sparse., Method: This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017. The primary efficacy endpoint was ischaemic stroke. The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality, non-fatal myocardial infarction and ischaemic stroke. The primary safety endpoint was ICH. The secondary safety endpoint was a composite of major bleeding events., Results: After adjustment of baseline characteristics by 1:1 propensity score matching, a total of 6220 patients (3110 on each group) were analysed. Compared with clopidogrel, potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke (HR 0.57; 95% CI 0.37 to 0.87; p=0.008) and a lower risk of thrombotic events (HR 0.77; 95% CI 0.66 to 0.90; p=0.001). Potent P2Y12 inhibitor was associated with similar risk of ICH (HR 0.65; 95% CI 0.34 to 1.25, p=0.20) and major bleeding (HR 0.83; 95% CI 0.68 to 1.01, p=0.069)., Conclusions: Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events, compared with clopidogrel. The risks of ICH and major bleeding were similar., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective To explore the effect of air temperature on the hospitalization of rural residents with cardiovascular diseases and its lag effect in Dingxi city. Methods The meteorological data and air pollution data of Dingxi city from 2018 to 2019,as well as the daily hospitalization data of rural residents due to cardiovascular diseases,were collected.The distributed lag non-linear models were employed to analyze the relationship between daily mean air temperature and the number of inpatients with cardiovascular diseases.Meanwhile,stratified analysis was carried out according to gender,age,and disease. Results There was a non-linear relationship between air temperature and the number of hospitalized rural residents with cardiovascular diseases in Dingxi city.The exposure-response curve approximated a bell shape.The curves for different cardiovascular diseases appeared similar shapes,with different temperature thresholds.Low temperature(-7 ℃) and moderately low temperature(0 ℃) exhibited a cumulative lag effect on the number of patients hospitalized with cardiovascular diseases.With a cumulative lag of 7 days at -7 ℃ and 14 days at 0 ℃,the RR values peaked,which were 1.121(95% CI =1.002-1.255) and 1.198(95% CI =1.123-1.278),respectively.With a cumulative lag of 14 days at 0 ℃,the RR values were 1.034(95% CI =1.003-1.077) and 1.039(95% CI =1.004-1.066) for the number of hospitalized patients with ischemic heart disease and heart rhythm disorders,respectively.The cumulative lag effects of moderately high temperature(17 ℃) and high temperature(21 ℃) on ischemic heart disease,heart rhythm disorders,and cerebrovascular disease all peaked on that day.Specifically,the RR values at 17 ℃ and 21 ℃ were 1.148(95% CI =1.092-1.206) and 1.176(95% CI =1.096-1.261) for ischemic heart disease,1.071(95% CI =1.001-1.147) and 1.112(95% CI =1.011-1.223) for heart rhythm disorders,and 1.084(95% CI =1.025-1.145) and 1.094(95% CI =1.013-1.182) for cerebrovascular disease,respectively.There was no cumulative lag effect of air temperature on the number of hospitalized patients with heart failure.In addition,stratified analysis showed that low temperature(-7 ℃) and moderately low temperature(0 ℃) affected the number of hospitalized female patients with cardiovascular diseases,and only moderately low temperature(0 ℃) affected males.The cumulative lag effect of high temperature on females was higher than that on males.Air temperature exhibited a stronger impact on female patients than on male patients. Additionally,the population aged<65 years old was more sensitive to low temperature and high temperature than that aged ≥65 years old. Conclusions Air temperature changes increase the hospitalization risk of rural residents with cardiovascular diseases in Dingxi city,which presents a lag effect.The effects of air temperature on patients hospitalized due to cardiovascular diseases varied among different etiologies,genders,and ages.It is necessary to emphasize on the impact of temperature changes on health in residents,especially for key populations such as females,people aged<65 years old,and those with ischemic heart disease.

Venous sinus stenosis is a rare cerebrovascular disease. The management of venous sinus stenosis remains controversial. The evidence-based medical evidence was limited. There was not a specific consensus or guideline on the disease. This expert consensus provides an overview of cerebral venous sinus stenosis and comprehensive recommendations for the diagnosis, management, and interventional treatment by reviewing the relevant literature. The intended audience includes physicians and other healthcare providers who are responsible for patients with cerebral venous sinus stenosis. The present consensus aims to standardize and improve the clinical practice of venous sinus stenosis in China.

Most studies of short-term exposure to ambient air pollution and cerebrovascular diseases focused on specific stroke-related outcomes, and results were inconsistent due to data unavailability and limited sample size. It is unclear yet how ambient air pollution contributes to the total cardiovascular mortality in central China. Daily deaths from cerebrovascular diseases were obtained from the Disease Surveillance Point System (DSPs) of Wuhan Center for Disease Control and Prevention during the period from 2013 to 2019. Air pollution data were obtained from Wuhan Ecology and Environment Institute from 10 national air quality monitoring stations, including average daily PM 2.5 , PM 10 , SO 2 , NO 2 , and O 3 . Average daily temperature and relative humidity were obtained from Wuhan Meteorological Bureau. We performed a Poisson regression in generalized additive models (GAM) to examine the association between ambient air pollution and cerebrovascular disease mortality. We observed a total of 84,811 deaths from cerebrovascular diseases from 1 January 2013 to 31 December 2019 in Wuhan. Short-term exposure to PM 2.5 , PM 10 , SO 2 , and NO 2 was positively associated with daily deaths from cerebrovascular diseases, and no significant association was found for O 3 . The largest effect on cerebrovascular disease mortality was found at lag0 for PM 2.5 (ERR: 0.927, 95% CI: 0.749-1.105 per 10 μg/m3) and lag1 for PM 10 (ERR: 0.627, 95% CI: 0.493-0.761 per 10 μg/m 3 ), SO 2 (ERR: 2.518, 95% CI: 1.914, 3.122 per 10 μg/m 3 ), and NO 2 (ERR: 1.090, 95% CI: 0.822-1.358 per 10 μg/m 3 ). The trends across lags were statistically significant. The stratified analysis demonstrated that females were more susceptible to SO 2 and NO 2 , while elder individuals aged above 65 years old, compared with younger people, suffered more from air pollution, especially from SO 2 . Short-term exposure to PM 2.5 , PM 10 , SO 2 , and NO 2 were significantly associated with a higher risk of cerebrovascular disease mortality, and elder females seemed to suffer more from air pollution. Further research is required to reveal the underlying mechanisms.

Objective: Cerebral arteriovenous malformation (AVM) is characterised by an abnormal tangle of arteries and veins, the rupture of which is a significant portion of the morbidity and mortality cases, especially in young populations. However, the exact risk factors and pathophysiologic mechanisms of AVM remain poorly understood. RNF213 variants have been identified as obvious susceptible factors of several cerebrovascular disorders, such as Moyamoya disease and intracranial aneurysms. Thus, this study aimed to determine whether there is an association between RNF213 rare variants and AVM., Methods: The AVM group included 22 patients with AVM. The control group included 1007 samples from the GeneSky in-house database and 208 samples from the 1000 Genome Project of Chinese Han Population. Genomic DNA samples were extracted from the peripheral blood of the AVM patients, and targeted exome sequencing of RNF213 was performed to assess the existence of low-frequency or rare variants. Sanger sequencing was performed to validate the identified variants. Logistic regression analysis was performed to calculate the odds ratios (ORs) and 95 % confidence intervals (CIs) of the candidate variants and risk of AVM. Statistical analyses were performed using SPSS version 21.0., Results: The RNF213 c.10997T>C variant (amino acid mutation p.M3666T, NM&#95;001256071) was observed in two AVM patients after filtration. It was significantly associated with AVM in the Chinese population (ORs, 10.30 and 25.08; 95 %; CIs, 1.38-77.10 and 4.34-144.90 compared with 1000 Genome Project of Chinese Han Population and GeneSky in-house database, respectively)., Conclusion: Rare variants of RNF213 are associated with AVM in the Chinese population, suggesting the important role of RNF213 in AVM. Further studies are needed to verify these findings., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To analyze the composition and differences of amenable mortality in urban and rural areas in China, 2010 and 2017. Methods: With the national mortality rates in 2010 and 2017 calculated by the National Bureau of Statistics and the National Health Commission as the reference, the underreporting rate from diseases was adjusted in combination with the cause-of-death surveillance data published by the Chinese Center for Disease Control and Prevention, and Center for Health Statistics and Information, National Health Commission. Age-standardized mortality was calculated by using a direct method based on the population census in 2010. Differences of the mortality in two years were compared, and the proportion of amenable mortality of different diseases in the total amenable mortality was calculated. Results: In 2010 and 2017, the age-standardized total mortality of non-communicable diseases was 536.4/100 000 and 493.6/100 000, respectively. The age-standardized amenable mortality rates were 107.6/100 000 and 96.0/100 000, respectively. Compared with 2010, the mortality of four major non-communicable diseases declined in 2017. The fastest declined amenable mortality was in with an average annual growth rate of -5.6%, followed by chronic respiratory diseases (-2.5%). Among the 11 subdivided non-communicable diseases, the age-standardized mortality of hypertension, chronic rheumatic heart disease and cerebrovascular disease declined, with an average annual growth rate of -6.7%, -5.8% and -3.0%, respectively. The proportion of amenable mortality from cerebrovascular disease was the highest among the 11 subdivided non-communicable diseases in 2010 and 2017, from 52.4% to 47.2%, followed by ischemic heart disease with an increase from 27.4% to 34.5%. Conclusion: Compared with that in 2010, the amenable mortality of non-communicable chronic diseases in urban and rural areas in China declined in 2017, of which cerebrovascular disease and ischemic heart disease account for more than 80%.

Cardiovascular disease has always been the most serious public health problem in China. Although many studies have found that the risk of death caused by cardiovascular disease is related to air pollutants, the existing results are still inconsistent. The aim of this study was to investigate the effects of air pollutants on the risk of daily cardiovascular deaths in Hefei, China. Daily data on cardiovascular deaths, daily air pollutants, and meteorological factors from 2007 to 2016 were collected in this study. A time-series study design using a distributed lag nonlinear model was employed to evaluate the association between air pollutants and cardiovascular deaths. First, a single air pollutant model was established based on the minimum value of Akaike information criterion (AIC), and the single day lag effects and multi-day lag effects were discussed separately. Then, two-pollutant models were fitted. Subgroup analyses were conducted by gender (male and female), age (< 65 age and ≥ 65 age), and disease type (ischemic heart disease and cerebral vascular disease). There were 34,500 cases of cardiovascular deaths during the period 2007-2016, and the average concentrations of air pollutants (PM 10 , SO 2 , NO 2 , PM 2.5 , CO, O 3 ) were 106.11, 20.34, 30.49, 72.59, 958.7, and 67.88 μg/m 3 , respectively. An increase of interquartile range (IQR) in PM 10 , SO 2 , NO 2 , PM 2.5 , CO, and O 3 were associated with an increase of 4.34% (95%CI 1.54~7.23%) at lag 0-6, 5.79% (95%CI 2.43~9.27%) at lag 0-5, 4.47% (95%CI 1.64~7.37%) at lag 0-5, 3.14% (95%CI 0.03~6.36%) at lag 0-4, 3.11% (95%CI 0.21~6.10%) at lag 0-3, and 8.17% (95%CI 1.89~14.84%) at lag 0-5 in cardiovascular deaths, respectively. Females, older group (≥ 65 years) and deaths from cerebral vascular disease were more vulnerable to air pollution than males, younger individuals (< 65 years) and deaths from ischemic heart disease. Our results suggest that air pollution increased the risk of cardiovascular deaths in Hefei. These findings can provide evidence for effective air quality interventions in Hefei.

Objective: To investigate the level and trend of cardiovascular disease mortality in China from 2002 to 2016. Methods: Using data of China Health Statistics Yearbook (2003-2012) and China's Health and Family Planning Statistical Yearbook (2013-2017),we calculated the age-standardized mortality rates (ASMR) in China. Joinpoint regression model was employed to estimate the annual percent change (APC) and average annual percent change (AAPC) of cardiovascular disease ASMR. Results: (1)The ASMR of cardiovascular disease were 225.65/100 thousands, 242.74/100 thousands, 214.63/100 thousands, 240.97/100 thousands, 195.24/100 thousands, 201.50/100 thousands, 208.83/100 thousands, 248.44/100 thousands, 261.38/100 thousands, 231.98/100 thousands, 210.25/100 thousands, 237.80/100 thousands, 235.21/100 thousands, 237.58/100 thousands,and 237.25/100 thousands from 2002 to 2016, and there was no significant difference in ASMR of cardiovascular disease (AAPC=0.2%, P> 0.05) . The ASMR of chronic rheumatic heart disease decreased significantly (AAPC=-4.5%, P< 0.05). There were no significant differences in ASMR of cerebrovascular disease, hypertensive heart disease, and ischemic heart disease (AAPC=0, P> 0.05; AAPC=2.0%, P> 0.05; AAPC=4.3%, P> 0.05, respectively). (2) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in city and country (AAPC=-0.7%, P> 0.05; AAPC=0.8%, P> 0.05, respectively). The ASMR of chronic rheumatic heart disease decreased significantly in city and rural area (AAPC=-4.4%, P< 0.05; AAPC=-4.6%, P< 0.05, respectively). (3) There were no significant differences in ASMR of cardiovascular disease from 2002 to 2016 in male and female (AAPC=-0.3%, P> 0.05; AAPC=-0.2%, P> 0.05,respectively). The ASMR of chronic rheumatic heart disease decreased significantly in female (AAPC=-4.2%, P< 0.05). The ASMR of ischemic heart disease increased significantly in male and female (AAPC=4.7%, P< 0.05; AAPC=5.2%, P< 0.05,respectively). (4) The ASMR of cardiovascular disease showed a significant upward trend in residents aged 15 to 34 from 2002 to 2016 (AAPC=3.1, P< 0.05). There were no significant differences in ASMR of cardiovascular disease in residents aged 35 to 64 and ≥65 (AAPC=-0.1%, P> 0.05; AAPC=-0.2%, P> 0.05, respectively). Conclusion: The ASMR of cardiovascular disease in China remains stable during 2002 to 2016, and the ASMR of cardiovascular disease shows upward trend among young people.

Objective: To determine the prevalence and associated factors of cognitive impairments in the community-dwelling elderly aged 60 years or older in Chengdu of Sichuan province., Methods: A random cluster sampling strategy was adopted to select 621 community-dwelling elderly. Face-to-face interviews were conducted to assess the cognitive status of the participants. 2 tests and logistic regression analyses were performed to identify factors associated with cognitive impairments., Results: About 40.9% of the participants had cognitive impairments. Those attended primary schools had a lower risk of cognitive impairments [odds ratio OR )=0.369, P <0.001] compared with the illiterate ones. Older age OR =1.505 for 70-79 years, P =0.042; OR =3.069 for ≥80 years, P <0.001), cerebrovascular disease OR =2.159, P =0.003) and smoking OR =2.388, P <0.001) were risk factors of cognitive impairments. Men had lower risk OR =0.489, P =0.005) of cognitive impairments than women., Conclusion: The prevalence of cognitive impairments in community-dwelling elderly in Chengdu is high in comparison with those in other cities. Illiteracy, older age (over 70 years), women, smoking, and cerebrovascular disease are risk factors of cognitive impairments., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Background and Purpose- Trimethylamine N-oxide (TMAO)-a gut derived metabolite-has been shown to be atherogenic. It remains unknown whether TMAO is associated with the risk of first stroke. We aimed to determine the association between serum TMAO levels and first stroke in hypertensive patients without major cardiovascular diseases and examine any possible effect modifiers. Methods- We used a nested case-control design, using data from the CSPPT (China Stroke Primary Prevention Trial), including 622 patients with first stroke and 622 matched controls. The study was conducted from May 2008 to August 2013. The primary outcome was a first stroke. Results- After adjusting for choline, L-carnitine, and other important covariates, including baseline systolic blood pressure and time-averaged systolic blood pressure, during the treatment period, the risk of first stroke increased with each increment of TMAO level (per natural log [TMAO] increment: odds ratio, 1.22; 95% CI, 1.02-1.46). Consistently, compared with participants in the lowest tertile (<1.79 μmol/L) of serum TMAO levels, a significantly higher risk of first stroke was found in those in higher TMAO tertiles (≥1.79 μmol/L; odds ratio, 1.34; 95% CI, 1.00-1.81) or in TMAO tertile 3 (≥3.19 μmol/L; odds ratio, 1.43; 95% CI, 1.02-2.01). In the exploratory analysis, we observed an interaction between TMAO and folate levels (≥7.7 [median] versus <7.7 ng/mL) on first stroke ( P for interaction, 0.030). Conclusions- Higher TMAO levels were associated with increased risk of first stroke in hypertensive patients. Our finding, if further confirmed, calls for a carefully designed clinical trial to further evaluate the role of higher TMAO levels on outcomes in hypertensive patients. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT00794885.

Objective: To analyze the epidemiological characteristics and trend of ischemic heart disease and cerebrovascular disease mortality among Xuzhou residents from 2011 to 2015. Methods: The mortality data of the ischemic heart disease and cerebrovascular disease were obtained from the registration disease surveillance system covering the residents of the city from 2011 to 2015. Ischemic heart disease and cerebrovascular disease were identified according to the international classification of diseases (ICD-10), Ischemic heart diseases include I20 to I25 (angina pectoris, acute myocardial infarction, certain current complications following acute myocardial infarction, other acute ischemic heart diseases chronic ischemic heart disease); cerebrovascular diseases include I60 to I69 (subarachnoid hemorrhage, intracerebral hemorrhage, other non-traumatic hemorrhage, cerebral infarction, stroke not specified as hemorrhage or infarction, other cerebrovascular diseases, sequelae of cerebrovascular disease). Results: (1)From 2011 to 2015, the chronic ischemia Cardio-Cerebrovascular disease mortality of residents in Xuzhou was 261.2 per one hundred thousand (129 950/49 748 321), 269.9 per one hundred thousand(69 562/25 775 930)for male residents, 252.0 per one hundred thousand(60 388/23 972 391)for female residents, the mortality rate in men was significantly higher than that in women ( P <0.05). The chronic ischemic Cardio-Cerebrovascular disease mortality rate of urban residents was 243.8 per one hundred thousand(17 049/6 993 787), which was lower than the rate of rural residents (264.0 per one hundred thousand(112 901/42 754 534), P <0.05). (2)From 2011 to 2015, the mortality rate of ischemic heart disease in Xuzhou city remained unchanged: 117.1 per one hundred thousand(11 416/9 747 768), 126.8 per one hundred thousand(12 177/9 600 745), 112.0 per one hundred thousand(11 184/9 986 877), 115.2 per one hundred thousand(11 697/10 151 842), 117.1 per one hundred thousand(12 019/10 261 089, P >0.05). The mortality rate of cerebrovascular disease were 154.0 per one hundred thousand(15 014/9 747 768), 155.9 per one hundred thousand(14 964/9 600 745), 143.5 per one hundred thousand(14 330/9 986 877), 135.5 per one hundred thousand(13 752/10 151 842), 130.6 per one hundred thousand(13 397/10 261 089)respectively, presented with a downward trend( P <0.05). The mortality rate of ischemic cerebrovascular disease were 62.7 per one hundred thousand(6 108/9 747 768), 74.7 per one hundred thousand(7 176/9 600 745), 72.3 per one hundred thousand(7 221/9 986 877), 70.9 per one hundred thousand(7 200/10 151 842)and 72.4 per one hundred thousand(7 431/10 261 089)respectively( P >0.05). The mortality rate of hemorrhagic cerebrovascular disease were 77.6 per one hundred thousand(7 562/9 747 768), 71.6 per one hundred thousand(6 873/9 600 745), 61.2 per one hundred thousand(6 115/9 986 877), 55.3 per one hundred thousand(5 613/10 151 842)and 46.4 per one hundred thousand(4 763/10 261 089)respectively, presented with a downward trend( P <0.05). (3)The average death age due to ischemic heart diseases of all residents was (77.0±13.1)years old, (76.4±13.2) years old among urban residents, (77.1±7.1 )years old among rural residents, (74.3±13.5)years old for male residents, (80.0±12.0) years old for female residents. The average death age due to ischemic cerebrovascular diseases of all residents was (76.4±11.9)years old, (76.5±12.3) years old among urban residents, (76.4±11.9 )years old among rural residents, (74.3±12.2)years old among male residents, (79.0±11.1) years old among female residents. From 2011 to 2015, the death age due to ischemic heart diseases were (76.3±13.5), (77.2±13.0), (76.6±13.3), (77.1±12.9)and(77.8±12.9)years old respectively; the death age due to cerebrovascular disease were (75.8±12.1), (76.3±11.8), (76.6±11.8), (76.6±12.0)and(77.1±11.9)years old respectively. The Spearman rank correlation analysis showed that the death age due to ischemic heart disease and cerebrovascular disease increased year by year in the past 5 years. ( r value was 0.033 and 0.038, respectively, all P <0.01). Conclusion: From 2011 to 2015, the mortality of hemorrhagic cerebrovascular disease decreased, while the mortality of ischemic cardiovascular and cerebrovascular diseases remained unchanged among Xuzhou residents.

Factors associated with orthostatic hypotension are heterogeneous, and some of the factors are interrelated and interdependent, which may confound their relationships to orthostatic hypotension. To investigate the factors that were most likely related to orthostatic hypotension, a study of community-dwelling persons (419 men and 309 women) was conducted. Blood pressures and heart rates were measured after the subjects had been recumbent for 5 min and upright for 1 min. A total of 119 persons (16.3%) experienced orthostatic hypotension. Univariate analysis showed that orthostatic hypotension was associated with the following variables: hypertension, diabetes mellitus, cerebrovascular disease, proteinuria, abnormal renal function, or medications use. Those patients with orthostatic hypotension were older in age and had a higher body mass index, seated blood pressure, plasma creatinine, hemoglobin A1c, fasting and 2-h postload glucose levels than those without orthostatic hypotension. Multivariate analysis revealed that diabetes mellitus, hypertension, and age were independently associated factors for orthostatic hypotension. The higher the level of plasma hemoglobin A1c (%) elevation, the higher the likelihood of orthostatic hypotension manifestation. Clinically, elderly persons or patients with hypertension or diabetes mellitus should receive regular monitoring of supine and upright blood pressure in order to detect orthostatic hypotension and prevent its complications.