Expert interviewed: Li Jian, deputy chief physician of the Department of Neurology, Aviation General Hospital
Global Times health client reporter Dong Changxi
Recently, the latest analysis data of mainland scholars based on the "global burden of disease" shows that the number of deaths from ischemic stroke (cerebral infarction) worldwide has increased from 2.04 million in 1990 to 3.29 million in 2019, and is expected to increase to 4.9 million by 2030.
The paper was published in the international journal Neurology and organized by the team of Professor Xiong Lize of Shanghai Fourth People's Hospital affiliated to Tongji University. This study summarizes and analyzes the geographical distribution and trend of global ischemic stroke disease burden from 1990~2019.
Studies have found that the burden of cerebral infarction in developing countries far exceeds that in developed regions, and the burden of cerebral infarction death is mainly in developing countries. Premature deaths caused by cerebral infarction are more serious in developing countries than in developed countries, and the trend of younger age is more obvious, among which the 40~44 age group has the highest growth trend.
In terms of gender, the mortality and disability rates of cerebral infarction in men are higher than those in women, and there is a clear downward trend in women compared with men, and this difference may be further widened in the future.
The study also found that there were seven major attributable risk factors for death and disability from cerebral infarction, including two behavioral factors, namely smoking and a high-salt diet, and five metabolic factors, including hypertension (high systolic blood pressure), hyperlipidemia (low density lipoprotein cholesterol, i.e. high LDL-C), renal insufficiency, hyperglycemia (elevated fasting blood sugar), and obesity (elevated body mass index, i.e., elevated BMI). Among them, obesity and hyperglycemia led to significant increases in age-standardized mortality and disability-adjusted life years. The research application model predicts that the number of deaths from cerebral infarction caused by the above seven risk factors will continue to increase in 2020~2030, and will increase to 4.9 million in 2030.
In this regard, the "Global Times Health Client" reporter interviewed Li Jian, deputy chief physician of the Department of Neurology of the Aviation General Hospital, who said, "The incidence of cerebrovascular disease in mainland China is very high, of which cerebral infarction accounts for the majority of cerebrovascular diseases. This study shows that the upward trend of cerebral infarction patients in young and low-income groups cannot be ignored. For individuals, increased attention and responsibility for their own health and proactive preventive measures are the most effective and cost-effective. In view of the above 7 risk factors, Li Jian gave countermeasures.
1. Smoking. The disadvantages of smoking are numerous, and the benefits of quitting smoking are immediate, but there are always people who continue to step into the ranks of "smokers". Although many people know that smoking causes lung disease, they may not know much about the fact that smoking greatly increases the risk of cerebral infarction. Long-term smoking can lead to decreased blood flow to brain tissue, leading to cerebral infarction. The smoking mentioned here includes not only direct smoking, but also "second-hand smoke" and "third-hand smoke".
Response: Aggressive smoking cessation.
2. High-salt diet. High-salt diet is extremely harmful to health, in addition to causing high blood pressure, increasing the risk of cardiovascular and cerebrovascular diseases, but also causing calcium loss, damage to the kidneys, stomach, and respiratory system. Salt reduction is one of the best interventions recommended by the World Health Organization and one of the most cost-effective ways to improve population health.
Response: salt reduction. Healthy people should not consume more than 5 grams of salt per day, and patients with high blood pressure and diabetic nephropathy should not exceed 3 grams. For those with heavier tastes, try a phased salt reduction, that is, a 5% reduction in salt intake per month or year.
3. High blood pressure. Hypertension is the most common and controllable risk factor for cerebral infarction, and there are more than 300 million patients with hypertension in mainland China, and many patients do not receive timely and effective treatment. Hypertension is an important risk factor for cerebral infarction, and the risk of cardiovascular and cerebrovascular diseases increases several times for every 20 mm Hg increase in systolic blood pressure or 10 mm Hg increase in diastolic blood pressure, so early recognition and strict monitoring of blood pressure is very important.
Countermeasures: Aggressively lower blood pressure and control systolic blood pressure (commonly known as "high pressure") below 140 mm Hg.
4. Hyperlipidemia. In patients with cerebral infarction or transient ischemic attack, intensive lipid lowering is an important treatment. The New England Journal of Medicine has published an article pointing out that if such patients reduce their LDL cholesterol levels to less than 70 mg/dL or more than 50%, it is beneficial to health.
Response: Aggressive lipid reduction. For patients with a history of cerebral infarction, it is recommended to control the level of LDL cholesterol below 70 mg/dL.
5. Renal insufficiency. Chronic kidney disease has been recognized by the American Heart Association as an independent risk factor for stroke, and the incidence of stroke in patients with kidney disease is higher than in the general population, and chronic kidney disease above stage 3 can increase the risk of stroke by 43%. A study conducted by the Karolinska Institute in Stockholm, Sweden, followed 330,000 elderly people for 5 years and found that people with poor kidney function and rapid decline in kidney function were more likely to develop vascular dementia.
Response measures: pay attention to kidney function, find abnormalities must seek medical attention in time, early treatment.
6. High blood sugar. The European Journal of Diabetes published a study that concluded that people who developed diabetes in middle age had a 30% increased risk of cerebral infarction (ischemic stroke) later on; People with type 2 diabetes may be more likely to have narrowing of blood vessels in the brain, which can lead to cerebral infarction.
Response: Aggressive blood sugar control. Diabetic patients advocate the "five carriages" principle of blood sugar control, that is, reasonable diet, more exercise, active medication, popular science education and self-monitoring.
7. Obesity. Excess weight or obesity can cause high blood pressure, diabetes, coronary heart disease, sleep apnea, etc., which are all risk factors for cerebral infarction. Studies have found that for every 10 kg of weight loss, blood pressure will be reduced by 5~10 mm Hg, and hypertensive patients can better control blood pressure by controlling their weight, while reducing the risk of diabetes and cardiovascular and cerebrovascular diseases.
Response: Active weight loss. The best way to control your weight is to stick to exercise and adjust your diet moderately, don't mess with diet pills, and don't advocate excessive dieting to lose weight. ▲
Responsible editor: Luo Rong
Editor-in-chief: Li Di