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A Nomogram to Predict Lifestyle Factors for Recurrence of Large-Vessel Ischemic Stroke

Authors Huang ZX, Yuan S, Li D, Hao H, Liu Z, Lin J

Received 4 November 2020

Accepted for publication 8 January 2021

Published 2 February 2021 Volume 2021:14 Pages 365—377


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Marco Carotenuto

Zhi-Xin Huang, 1– 3 Shumin Yuan, 4 Dongshi Li, 1, 3 Hong Hao, 2 Zhenguo Liu, 2 Jianguo Lin 1, 3

1Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China; 2Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA; 3Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China; 4Department of Biochemistry and Molecular Biology, Guilin Medical University, Guilin, Guangxi, China

Correspondence: Zhi-Xin Huang
Department of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou, 510317, Guangdong, China
Tel/Fax +86 20 89168080

Zhenguo Liu
Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA

Background: Stroke is the leading cause of morbidity and mortality in China. Recurrent stroke (RS) could occur in a significant portion of patients with ischemic stroke with devastating consequence.
Methods: To investigate the association between lifestyle and the risk of RS in Chinese patients with acute large-vessel ischemic stroke (ALVIS). A total of 258 patients with ALVIS were recruited in the study (median age 63 years, 30.6% female), and followed for a median of 366 days. The primary outcomes were first RS. Cox Regression and Akaike information criterion were used to establish the best-fit nomograms.
Results: During follow-up, 38 of 258 (14.7%) participants had the primary endpoint event. After adjusting for confounding factors in multivariate Cox regression analysis, healthy lifestyles, including bland diet (hazard ratio [HR], 0.365; 95% CI, 0.138– 0.965), daily fruit consumption (HR, 0.474; 95% CI, 0.238– 0.945), good sleep (HR, 0.364; 95% CI, 0.180– 0.739), housework: HR (0.461; 95% CI, 0.200– 1.065), and HDL (HR, 0.329; 95% CI, 0.130– 0.831) were associated with significantly decreased risk for RS after ALVIS, while smoking was associated with a substantial increase in RS risk (HR, 2.590; 95% CI, 1.340– 5.005) and included into the nomogram. A weighted point (from 0 to 100) was given to each risk factor, and the total points could be used to predict the probability of RS for the patient.
Conclusion: The nomogram shows that healthy lifestyles (bland diet, daily fruit consumption, good sleep, cigarette cessation, and housework) were important for reducing RS in patients with ALVIS.

Keywords: recurrent event, lifestyle, ischemic stroke, stroke, nomogram

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