The experience of Huashan God inside big coffee: these people are more prone to stroke

*Only for medical professionals to read for reference.
October 29, 2021 is the 16th World Stroke Day.
The medical profession and the "Huashan Hospital Neurology" will take you to understand these things
.

 According to the "China Stroke Report 2019" data, in 2018, the death rate of Chinese residents from cerebrovascular disease was 149.
49 per 100,000 (the death toll is about 1.
57 million), ranking third, and it is increasing year by year.
The global burden of disease in 2017 shows , The premature loss of life years caused by stroke ranks first, and the burden of disease is very serious
.

October 29, 2021 is the 16th "World Stroke Day".
The National Health Commission’s Brain Defense Commission and the Chinese Stroke Society released this year’s theme as "Be alert to stroke symptoms, identify and treat as soon as possible!" Invitation "Huashan hospital Department of Neurology," the deputy director Ding Yan Wang, MD, on "high-risk factor for stroke What? who is more prone to stroke?" and so on are discussed
.

What are the high risk factors for stroke? Dr.
Ding Hongyan introduced that the main risk factors for stroke that cannot be prevented are age, gender, race, genetic history, etc.
: Age: Generally, men over 60 years old and women after menopause have significantly increased risk factors for stroke
.

Gender: Men tend to be higher than women
.

Race: The incidence of Asians and blacks is often higher than that of white races
.

Genetic factors: People who have had a history of stroke in their family history have a risk of 2-3 times higher than others
.

Birth weight: underweight (<2.
5kg) or overweight (>4kg), the risk factors for stroke are increased, but for patients with low birth weight (<2.
5kg), the risk factors for stroke are relatively higher Taller
.

Dr.
Ding Hongyan emphasized that these factors are uncontrollable and we cannot intervene
.

As for preventable high-risk factors, Dr.
Ding Hongyan introduced that compared with uncontrollable factors, there are relatively more controllable factors.
There are about ten common risk factors, including hypertension, diabetes, dyslipidemia, heart disease, etc.
Among heart diseases, the most dangerous are patients with atrial fibrillation, followed by acute myocardial infarction, acute arrhythmia, and infectious cardiomyopathy
.

The occurrence of stroke is also related to daily living habits, such as obesity, lack of exercise, smoking, drinking, etc.
These are high-risk factors that increase the risk of stroke
.

Some diseases may also become high-risk factors, including sleep apnea syndrome (common in the elderly, with snoring symptoms that make it hypoxic at night), hyperhomocysteinemia (by blood testing for homocysteine) acid level), women after menopause women use oral contraceptives or estrogen replacement therapy, migraine, a small portion of drug users, such as patients with asymptomatic carotid stenosis
.

How to identify people at high risk of stroke? The gold standard for evaluation? Dr.
Ding Hongyan pointed out that there is a misunderstanding about stroke in society at present, that is, it is believed that stroke only occurs in the elderly and not in young people.
In fact, this is wrong
.

Stroke is actually a disease that can occur in the entire population.
It is not only limited to the elderly, but also includes people of different age groups (infants, children, adolescents, middle-aged people, etc.
), but only in different age groups.
The risk factors and predisposing factors of stroke are different, so in the process of diagnosis and treatment, we need to pay special attention to finding the cause of the patient
.

1) A patient with a family history refers to a first-degree relative who has a family history of stroke before the age of 65.
The incidence of stroke is 2-3 times higher than that of others; in terms of age group Men over 60 years of age or women after menopause are all prone to stroke; the incidence of stroke in patients with atrial fibrillation also increases with age, and the risk of stroke in women with atrial fibrillation over 80 years of age increases by 4-5 times
.

2) How can I tell if I will have a stroke? How high is the risk of stroke? In response to this problem, Dr.
Ding Hongyan pointed out that stroke is a multi-factor disease that requires comprehensive consideration of many factors.
Therefore, at this time, we can use some tools or scales to assess the risk factors of stroke
.

a) The earliest is the Framingham Stroke Scale, which is divided into males and females.
It is used to predict the risk of stroke in the next 10 years, from age, untreated systolic blood pressure, post-treatment systolic blood pressure, diabetes, smoking, cardiovascular disease, Atrial fibrillation, cardiovascular disease, left ventricular hypertrophy and other aspects were evaluated (see Figure 1, Figure 2)
.

Figure 1 Modified Framingham Stroke Scale (male) Figure 2 Modified Framingham Stroke Scale (female) b) Essen Stroke Risk Rating Scale (ESRS), ESRS for secondary prevention, based on the CAPRIE trial The result, which is mainly used in clinical trials, is a stroke tool developed for the analysis of stroke subgroups
.

Relatively simple, strong maneuverability
.

ESRS total score is 0-9, total score 0-2 is low risk, total score 3-6 is medium risk, stroke recurrence risk is 7-9%; 6 points or more is high risk, stroke recurrence risk Up to 11% (see Figure 3)
.

Figure 3 Essen scale Dr.
Hongyan Ding suggested that when conducting risk assessment, for young and middle-aged patients, you can choose a scale that suits you for preliminary assessment
.

For elderly patients, it is recommended that they go to the neurology specialist outpatient clinic for evaluation by a professional doctor
.

For different groups of people, how to prevent stroke from happening? Dr.
Ding Hongyan introduced that different age groups have different risk factors for stroke.
It is necessary to know oneself and the enemy, that is, to have a full understanding of the etiology of different stroke populations in order to carry out targeted interventions to prevent strokes more effectively
.

1) For strokes in children, the main factors are heredity, hypercoagulability caused by blood diseases, and congenital abnormalities of cerebrovascular development (such as arteriovenous malformations, etc.
)
.

Because of these reasons, patients can cause stroke at an early stage, and these factors are not preventable
.

For children, preventable high-risk factors include blood diseases caused by infection (such as new coronary pneumonia, etc.
), or infections caused by herpes simplex virus, bacteria, and fungi
.

At this time, it is necessary to strengthen exercise, enhance nutrition and improve physical fitness to prevent the occurrence of stroke
.

2) For young people's strokes, their bad living habits (smoking, drinking, staying up late, etc.
) are common causes that may lead to strokes.
Therefore, it is recommended to prevent them by improving their living habits and strengthening exercises
.

On the other hand, young patients may cause strokes due to excessive exercise.
Patients who have been in a state of high-intensity exercise for a long time may have arterial dissection or large-area cerebral infarction.
In response to this situation, Dr.
Ding Hongyan recommends that you need to choose Suitable for your own exercise and moderate exercise
.

For some patients with high blood pressure and hyperlipidemia, it is often not up to the standard to control blood pressure and blood lipids only through physical exercise and dietary changes.
It is recommended that patients undergo standardized treatment, if necessary (usually patients who have not reached the standard for more than 3 months).
Plus drugs to cooperate with treatment
.

3) For elderly patients, including menopausal women, disease factors are the main factors.
In addition to changes in diet, sports, and living habits, prevention of stroke requires regular physical examinations to understand their own physical condition and self-understanding.
And give corresponding control to the underlying diseases (such as hypertension and other diseases)
.

In addition, Dr.
Ding Hongyan also emphasized that the disease is not only to be controlled, but to reach the target, and the target level needs to be adjusted according to the individual to more effectively prevent the occurrence of stroke
.

In summary, stroke is preventable and treatable.
Early identification of high-risk groups and targeted interventions can avoid tragedies
.

 Expert profile Ding Hongyan, Deputy Chief Physician and Doctor of Medicine, Department of Neurology, Huashan Hospital Affiliated to Fudan University, Deputy Chairman of the Youth Committee of the Shanghai Medical Association Stroke Branch, Standing Committee Member of the Neurorehabilitation Professional Committee of the Shanghai Rehabilitation Medicine Association Member of the Cerebral Venous Disease Branch of the Chinese Stroke Society Research on vascular diseases, especially on cerebral hemorrhage and intracranial venous system thrombosis 2010/09-2011/09, I was a foreign researcher at Aichi Medical University, Japan, engaged in basic research on cerebral hemorrhage
.

May-August 2018, Japan’s Aizawa Hospital (President Unit of the Japanese Medical Association) Department of Neurology Advanced Neurological Rehabilitation 2017 Key Research and Development Program of the Ministry of Science and Technology Digital Diagnosis and Treatment Project “Research and Application of Clinical Standardized Treatment of Non-invasive Cerebral Edema Monitor” sub-project responsible He has published more than 30 papers, more than 10 SCI papers, and participated in the compilation of "Practical Internal Medicine", "Practical Neurology" and other books
.

Won the second prize of the Shanghai Medical Science and Technology Award in 2007, and the first prize of the Shanghai Science and Technology Award in 2013