Risk Assessment Of Stroke In Physical Examination Population Based On HRA Model

Abstract: Stroke is the leading cause of death in China. According to the Chinese stroke screening and prevention project, eight main risk factors were assessed and individuals with three or more risk factor were identified as high risk population of stroke. To explore the potential impropriety of counting the risk factors but ignoring the different strength of association of each risk factor, to detect high-risk groups more efficiently, a health risk appraisal (HRA) model should be performed to assess individual risk of stroke.Methods: Relevant databases were searched for case-control and cohort studies focusing on the risk factors of stroke. We systematically identified studies conducted between 1990 and 2015 that included data on the frequency of risk factors in Chinese Han populations. Pooled relative risks and odds ratios, with their 95% confidence intervals, were calculated for the cohort and case-control studies, respectively. The odd ratios for the eight main risk factors of stroke were used to develop a HRA model to predict individuals 'risks of developing stroke in the next five years. The CSSPP and HRA screening strategies were then compared.Results: Fifteen cohort studies and 178 case-control studies were identified.Hypertension was the strongest independent risk factor for stroke (pooled odd ratio,3.50; pooled relative risk, 2.68). Diabetes mellitus, heart disease, family history of stroke, hyperlipidemia, overweight, and smoking were also mildly predictive (pooled odd ratios, 1.82-2.68; pooled relative risks, 1.27-2.47). By contrast, physical exercise was a protective factor against stroke (pooled odd ratio, 0.49).We assessed 4196 individuals receiving check-ups. The average 5-year risk of stroke was 1.33‰, with males being at higher risk of stroke than females over that period. The average 5-year risk of stroke also increased with the number of risk factors. Using the CSSPP, 918 individuals (21.9%) were identified as high risk, but 219 individuals with fewer than three risk factors were considered low risk despite having a 5-year risk of stroke greater than 2.5% by our assessment. Notably, among those with hypertension and diabetes who were classified as low risk by the CSSPP, the HRA recognized 10.5% and 9.4%as being at high risk, respectively.Conclusions: There was a measurable difference in the strength of association of the eight risk factors with stroke: hypertension and diabetes were associated with the highest risks, indicating a need to focus resources on patients with these conditions.Giving risk factors equal weighting may not be an appropriate screening methodology.The efficiency of clustering these risk factors might be improved by considering the relative risk of each factor with a HRA tool.