Risk Management and Healthcare Policy (Feb 2021)
A Nomogram to Predict Lifestyle Factors for Recurrence of Large-Vessel Ischemic Stroke
Abstract
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, ChinaCorrespondence: Zhi-Xin HuangDepartment of Neurology, Guangdong Second Provincial General Hospital, 466 Middle Xingang Road, Guangzhou, 510317, Guangdong, ChinaTel/Fax +86 20 89168080Email [email protected] Zhenguo LiuCenter for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USAEmail [email protected]: 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
