Objective To evaluate the effectiveness of screening-intervention management program for high risk population of stroke in community.Methods Participants aged≥60 years old in Tairi Community,Fengxian District,Shanghai from May 2019 to July 2022 were selected as screening and intervention objects.The first round of stroke high-risk group screening was conducted in 2019 and 2020 in two years respectively,and the second round of stroke high-risk group screening(re-screening)was conducted in 2021 and 2022 respectively for the 2019 and 2020 screening groups,and the groups who had received stroke high-risk screening in both rounds of screening(overlapping groups)were selected as the observation objects of this study.The cerebrovascular function score was used to screen the high-risk individuals of stroke,75-100 was classified as non-high-risk,＜75 were classified as high risk,among which 50-74,25-49,0-24 were light,medium and severe risk,in turn.Baseline and follow-up data were collected for all screening groups,including systolic blood pressure,diastolic blood pressure,overweight or obesity,fasting blood glucose,glycated hemoglobin,triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,and blood uric acid.After the completion of screening,the test report interpretation and first diagnosis intervention were carried out on the screening site,and the screening results were recorded into the health examination file.The first intervention includes lifestyle intervention,risk factor intervention and therapeutic intervention for high-risk individuals.Lifestyle intervention and risk factor intervention were conducted through the distribution of popular science handbook for stroke prevention and individualized face-to-face guidance.Therapeutic intervention for high-risk individuals was guided by anti-platelet aggregation drug therapy,statin therapy,and further examination and treatment of cerebral vessels according to stroke risk assessment results and the incidence of related chronic diseases.Prior to the implementation of the project,the incidence of stroke in the community in 2018 was retrospectively investigated to compare annual changes in stroke screening-intervention.In the process of implementation of intervention management,stroke incidence monitoring of the whole community registered population was carried out,and the monitoring method was to conduct stroke incidence registration once a year,and cooperate with the disease control and community police station to obtain the community stroke incidence monitoring data and death registration information provided by the police station from 2018 to 2022.Results A total of 5 188 subjects who completed both the initial screening and the follow-up screening and met the inclusion and exclusion criteria were identified,of whom 2 269 were male and 2 923 were female.The age of participants ranged from 60 to 93 years at the time of the first round of screening,with a mean age of(68±6)years.The proportions of subjects in the age groups of 60-64,65-69,70-74,and≥75 years were 30.3％,34.7％,21.1％,and 14.0％,respectively.(1)After screening and intervention,the proportion of individuals with increased systolic blood pressure,diastolic blood pressure,fasting blood glucose,triglyceride,and low-density lipoprotein cholesterol all decreased(respectively 49.4％vs.57.3％,26.6％vs.28.7％,9.6％vs.10.9％,14.7％vs.17.0％,2.4％vs.3.3％;all P＜0.05),but the proportion of individuals with hyperuricemia increased(15.8％vs.13.1％,P＜0.01),with statistically significant differences.(2)Before the implementation of the screening-intervention program in 2018,the stroke incidence rate in the community was 332.1/100 000.The stroke incidence rates in the community during the period from 2019 to 2022 after the implementation of the screening-intervention program were 335.0/100 000,270.8/100 000,235.0/100 000,and 193.6/100 000,respectively.The incidence rates of ischemic stroke(x2trend=8.350,P=0.004)and stroke(x2trend=9.910,P=0.002)decreased during the period from 2019 to 2022,while the incidence rate of hemorrhagic stroke did not show a decreasing trend(x2trend=1.636,P=0.201).(3)The median baseline and follow-up cerebrovascular function scores for the 5 188 elderly individuals undergoing residual stroke risk screening were 82.50(52.50,98.75)and 88.5(59.00,100.00),respectively,with stroke risk rates of 39.8％and 35.6％before and after intervention,respectively.After intervention,the follow-up cerebrovascular function scores increased compared to the baseline,and the stroke risk rate decreased.The distribution of stroke risk levels before and after screening-intervention had statistically significant differences(P＜0.01).Conclusion Implementing a stroke high-risk population screening-intervention management program for the elderly in the community,combined with health examinations and family doctor team services,can significantly reduce the incidence,high-risk rate,and exposure level of risk factors for stroke in the community.

Objective:To analyze and compare the risk factors for hemorrhagic stroke and ischemic stroke and understand the exposure levels in population.Methods:A cohort study of risk factors of stroke was conducted in a rural community in Fengxian District of Shanghai in 2003, and the common risk factors of stroke were investigated at baseline survey, the cerebrovascular hemodynamics indexes were detected, the cerebrovascular function score was calculated according to the unified integral rule, and the incidence of stroke was observed in follow up. The risk factors for hemorrhagic stroke and ischemic stroke were analyzed by cohort study. The risk factors for two subtypes of stroke were compared.Result:A total of 10 565 participants were included in the study, with a mean follow-up period of (11.15±2.26) years, and 103 hemorrhagic stroke cases and 268 ischemic stroke cases were observed during follow-up period. The independent risk factors of hemorrhagic stroke included decreased cerebrovascular function score [hazard ratio ( HR)=1.56, 95% CI: 1.23-1.98], history of alcohol consumption ( HR=2.46, 95% CI: 1.39-4.34), hypertension ( HR=1.75, 95% CI: 1.00-3.07) and older age ( HR=1.07, 95% CI: 1.04-1.10). The independent risk factors of ischemic stroke included decreased cerebrovascular function score ( HR=1.43, 95% CI: 1.25-1.65), smoking history ( HR=1.52, 95% CI: 1.13-2.05), hypertension ( HR=1.51, 95% CI: 1.10-2.07), family history of stroke ( HR=1.89, 95% CI: 1.13-3.15), left ventricular hypertrophy ( HR=1.74, 95% CI: 1.07-2.81) and older age ( HR=1.07, 95% CI: 1.05-1.08). Conclusions:Decreased cerebrovascular function score, hypertension, and older age were common independent risk factors of both types of stroke, alcohol consumption history was an independent risk factor of hemorrhagic stroke, and smoking history, and family history of stroke and left ventricular hypertrophy were independent risk factors of ischemic stroke.

Objective:To establish a 10-year comparison table of cerebrovascular function score and first stroke risk, and to provide a new method for screening of high-risk population of stroke.Methods:In the beginning of 2003, a cohort for studing stroke risk factors in those aged 40 years and over was established in a community of Shanghai by cluster sampling. The common risk factors of stroke were investigated with a unified questionnaire, and the cerebrovascular function (cerebral vascular hemodynamic indexes, CVHI) was measured. The baseline study was completed from April to June 2003 and December 2004 to January 2005, respectively. The incident of first stroke and all cause of death were followed up year by year. The follow-up period was up to December 31, 2014. The 10-year incidence of first stroke was calculated according to the baseline score of cerebrovascular function, and the score-risk control table was established to estimate 10-year first stroke risk in each score group. The role of cerebrovascular function score in stroke was also estimated.Results:The follow-up term of 10 565 participants was (10.26±2.00) years, and 350 patients had first stroke during the follow-up. The trend 10-year incidence of first stroke both in men and women was significantly increased with the decrease of the score of cerebrovascular function (trend χ2=296.125, P<0.01). As the 10-year risk of first stroke was higher than 5% and higher than 10%, the corresponding CVHI score was lower than 70 and 40 points in males and lower than 30 and 20 points in females. When the scores of cerebral vascular function were divided by every 25 points, incidence of first stroke in each group from top to bottom was 1.9%, 4.7%, 10.8%, 15.2% in males and 1.6%, 4.4%, 4.8%, 11.4% in females, respectively. As compared to the top, the relative risk (95% CI) of first stroke in the lower groups was 2.61(1.67-4.07), 6.46(4.22-9.89), 9.74(6.53-14.52) for males and 2.82(1.93-4.12), 3.15(1.99-4.99), 8.12(5.65-11.68) for females, respectively. Multivariate analysis showed that the factors being selected into the regression equation were cerebrovascular function score, age, hypertension history, stroke family history and smoking history, among which the role of cerebrovascular function score was the strongest. Conclusion:The risk of first stroke increases significantly with the decrease of cerebrovascular function score, which can be used to assess the 10-year risk of first stroke.

Objective: This study aimed to analyze and summarize the implementation of the primary prevention program for stroke in Shanghai rural community and evaluate its preventive effect. Methods: A cluster sampling method was used to select approximately 50 000 community natural population from a town in Fengxian District of Shanghai. A primary stroke prevention program was established and implemented in the community from 2008 to 2010 and from 2012 to 2015. The prevention program inclueded stroke health education for the whole population, screening of high risk population of stroke, and therapeutic intervention and management plan for individuals aged≥50 years. The intervention measures were followed up every 2 months. From 2008 to 2015, new stroke cases were monitored dynamically and reviewed annually with classification of stroke diagnosis. The effect of community primary prevention of stroke program was evaluated by the dynamic changes in stroke incidence. Results: From 2008 to 2015, a total of 422 600 individuals were monitored, including 20 500 men and 217 600 women. In 2008, 7 828 individuals were screened and 2 129 individuals were at high risk of stroke were screened, with a high risk rate of 27.2%. In 2012, 2 877 individuals were screened, and 725 individuals were at high risk of stroke were screened, with a high risk rate of 25.2%. The standardized incidence of stroke in this community was 158.1, 105.4, 86.6, 77.6, 89.3, 77.4, 50.7, and 42.3 per 100 000 respectively. The overall incidence image roughly showed a downward trend except 2012(trend test P<0.01). There was no significant difference in the incidence of stroke between men and women in each year. The incidence of stroke increased significantly with age (trend test P<0.01). The age composition of stroke patients is slightly different between different sexes. The proportion of male patients with stroke aged <70 years was significantly higher than that of female patients with stroke, while the proportion of female patients with stroke age>70 years was significantly higher than that of male patients with stroke (P<0.01). Cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage accounted for 20.76%, 75.14%, and 4.10%, respectively. Conclusion Based on lifestyle intervention and treatment and control of risk factors, screening high-risk individuals for therapeutic intervention in community population can significantly reduce the incidence of stroke.

Objective To evaluate the efficacy of the traditional Chinese medicine NAOAN capsule in primary prevention of stroke in high?risk populations. Methods A multicenter, randomized controlled study was performed in community setting, involving 1 088 individuals at high risk of stroke, with cerebrovascular function scores<75 and 10?year Framingham stroke risk ≥6%. Subjects were recruited in communities at Beijing, Shanghai, Changsha, and Chengdu communities, through resident committees or the village unit. A total of 559 subjects were randomized into a group treated with the NAOAN capsule, and 529 subjects in an aspirin treatment group. Follow?up was performed every 2 months for 2 years. At the mid?point and end of the intervention, we compared cerebrovascular function differences between the 2 groups. Results During the 2?year community trial, 531 subjects in the NAOAN capsule group and 465 in the aspirin group followed the protocol. Cerebrovascular function scores increased from 45.2±19.7 at baseline to 61.7±26.5 after the 2?year trial (t=－12.931, P<0.001) in the NAOAN capsule group, and from 47.2±18.9 at baseline to 53.7 ± 25.1 (t=－5.058, P<0.001) in the aspirin group; greater increases in cerebrovascular function scores were found in the NAOAN capsule group than that in the aspirin group (t=4.906, P<0.001). Conclusions Cerebrovascular function in individuals at high risk of stroke was improved by taking NAOAN capsule. Cerebrovascular function scores improved more with NAOAN capsules than with aspirin.

Objective To investigate the changes of cerebrovascular hemodynamic accumulative score in health checkup population and their influencing factors.Methods A total of 1 840 people aged 23-88 years were checked by CVHI and accumulative scores were calculated.The general information,blood biochemistry,highly sensitive C-reaction protein (hs-CRP),homocysteine (Hcy),carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (baPWV) were also collected during the corresponding period.Results The proportion of abnormal CVHI accumulative score (＜75 points) was increasing with age.Compared with the normal CVHI accumulative score (≥75 points) group,the proportion of hypertensive disease,diabetes and stroke family history was significantly higher in the abnormal group (P＜ 0.05).In addition,the levels of age,body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),fasting plasma glucose (FPG),hs-CRP,Hcy,CIMT and baPWV were also significantly increased in the abnormal group (P＜0.05).Correlation analysis showed a negative correlation between CVHI accumulative score and age,history of hypertension,diabetes,BMI,WC,SBP,DBP,LDL-C,TG,FPG,hs-CRP,Hcy,baPWV (P＜ 0.05),but a positive correlation with HDL-C (P＜0.05).Multiple factor analysis determined that age [OR(95％C1):1.017(1.002-1.033)],history of hypertension [OR(95％CI):1.510(1.096-2.081)],BMI [OR(95％CI):1.235(1.135-1.344)],SBP [OR(95％CI):1.044(1.030-1.059)],LDL-C [OR(95％CI):1.673(1.444-1.937)],TG [OR(95％CI):1.116(1.035-1.204)],hs-CRP [OR(95％CI):1.037(1.003-1.073)],Hcy [OR(95％CI):1.099(1.062-1.136)],baPWV [OR(95％CI):1.001(1.000-1.002)] were being selected into the regression model (P＜0.05),and they were independent influencing factors of decreased CVHI accumulative scores.Conelusion The decreased CVHI accumulative score has a significant relationship with exposure levels of risk factors in stroke.Therefore,we conclude that the detection of CVHI is a convenient and feasible method to screen high risk individuals for stroke in middle and old aged population undergoing medical examination.

Objective To analyze the relationships between body mass index (BMI), blood pressure and the cerebral vascular function in middle-aged population that underwent health checkup. Methods Participants from health management centers of Renmin Hospital of Hubei province, the Second Hospital Affiliated to Nanhua University, Hospital of Shandong Electric Power and Chinese People's Liberation Army No. 180 Hospital aged 45 to 64 years were selected from health checkup population by cluster sampling. Levels of height, weight and blood pressure as well as the cerebral hemodynamics were checked. Subjects were grouped according to age, BMI, systolic and diastolic blood pressure. The differences and distribution of cerebrovascular function scores (CVFS) between groups were compared and described. Moreover, the risk of stroke in the population was evaluated. Results Of the 17 258 individuals who met inclusion criteria, the abnormal rate (the score below 75 points) of CVFS was 20.9 percent. The CVFS in normal, overweight and obese groups were 91.0±15.4, 83.3±21.3, 70.3±26.5 and differences in all age groups were statistically significant (P<0.01). The CVFS in systolic blood pressure<120,120-139, 140-159,≥160 mmHg (1 mmHg=0.133 kPa) groups were 93.9±12.9, 86.5±18.9, 72.1±23.5, 56.2±25.7 and differences in all age groups were statistically significant (P<0.01). CVFS in normal diastolic pressure<80, 80-89, 90-99,≥100 mmHg groups were 91.0±16.1, 85.5±20.2, 75.4±23.6, 62.7±25.0 and the differences among all age groups were statistically significant (P<0.01). Conclusions The abnormal rate of cerebrovascular function integral and high risk stroke individuals in middle-aged health checkup people was approximately 21 percent. The overweight, obese and the high level of systolic and diastolic pressure may induce the injury of cerebrovascular function and the severity will increase with the level of BMI and blood pressure.

Objective: To compare the accumulative scores of cerebrovascular hemodynamic parameters (CVHP) in different populations and to analyze the relationship between the change of accumulative scores and the risk of stroke. Methods: A total of 10 565 participants aged 40 years and above were selected from a cluster sampling community-based population. Their risk factors were investigated and CVHP was evaluated. The CVHP scores were accumulated by a unified approach, and the incidence of stroke was followed up. The participants were grouped into health adult, single factor exposure, multiple-factor exposure, and newly developed stroke during the follow-up period. The differences of CVHP accumulative scores and the change law among the 4 groups were compared respectively according to age and sex. Results: The accumu-lative scores of the mean (SD) CVHP in the health adult, single factor exposure, multiple-factor exposure, and newly developed stroke groups were 86.44 (20.69), 72.07 (28.10), 60.82(34.64), and4.01 (29.36) in men respectively, and they were 83.95 (22.19), 67.97 (29.73),59.91 (31.34), and 42.64 (28.00) in women respectively, which had a tendency to gradually decrease. The accumulative scores of CVHP and their distributions at the same age stage in all the 4 groups had significant differences (P ＜ 0.01 ). The accumulative scores of CVHP and their distributions for the same factors between all age groups also had significant differences (P ＜0. 01). Conclusions: The accumulative scores of CVHP had a tendency to gradually decrease from the health adults, risk factor exposure to high risk status before stroke. The decrease of the accumulative scores is closely associated with the increase of stroke risk, which can be used as a predictor of stroke.

Objective To find out exposure level and distributional characteristics of risk factors for stroke in sampling population among communities. Methods Target population aged≥40 years were selected from Beijing,Shanghai,Fuzhou and Tangshan by cluster sampling and grouped by area,age and gender. They were investigated face to face with a questionnaire which included general information and common risk factors of stroke. Body height,weight and levels of blood pressures were measured. Exposure rate of risk factors and its distributional characteristics of area and population were described. Results 23 471 individuals were enlisted into data analysis. Exposure rate of hypertension,heart disease,diabetes,family history of stroke,obesity,cigarette smoking and alcohol drinking were 27.73%,14.14%,5.19%,15.95%,11.28%,28.7% and 16.6%,respectively. There were significant differences between areas for all factors (P

Objective To observe the changes of cerebrovascular hemodynamic index(CVHI) in atherosclerotic rabbits. Methods Twenty male New Zealand rabbits were randomly divided into two group: Twelve were atherosclerosis model (AS) group and eight were control group. Atherosclerosis model group were fed with high fat diet and control group were fed with ordinary diet. At 12th week, CVHI were measured in the common carotid artery with spectral analysis and the compliance of carotid was observed. Results In the AS group, the carotid artery maximal velocity (vmax) and minimal velocity (vmin) were significantly decreased (P