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过去20年间，中国的缺血性中风比率就和经济一样“成长”了。
一篇大型的长期族群基础研究显示，1984至2004年间，中国的缺血性中风比率增加约9%。
该研究的主要作者，北京安贞医院的Dong Zhao博士表示，在中国经济快速成长的这段期间，人民的生活型态和健康也改变，造成中风比率和中风死亡率的改变。
Zhao博士在美国中风学会的一篇声明中表示，中风类型的改变已经对中国的中风预防政策带来新的改变。
该研究于2月28日线上发表于中风(Stroke)期刊。
【独特的研究】
根据该研究，之前的族群基础研究认为贫困和某些中风特征有关，有比较多的出血性中风、中风发生年龄较轻、 比较多致命中风、中风造成的死亡比心脏病多。
作者指出，如果这样，中风比率应该随着经济成长而降低，不过，几乎没有研究检视这个假设，这是第一次进行这种研究。
世界心脏联盟的流行病与与预防委员会主席Zhao博士表示，之前没有资料可以提供有关发展中国家的大族群基础的中风发生率，以及病例致死率的前溯且长期趋势作为中风流行病学之变迁。
为了检视中国经济快速成长期间的中风流行病趋势，研究者使用“Sino–Monitoring Trends and Determinants in Cardiovascular Disease Project (MONICA)–北京”这项研究的资料，追踪北京在1984至2004年间的中风和心血管疾病发生率和死亡率。
在研究期间，总共有14,585名年纪在25至74岁者发生中风，分析发现平均每年增加8.7% 的缺血性中风以及增加1.7%的出血性中风；不过，两种中风类型的整体死亡率都下降—出血性中风是1.7%、缺血性中风是 0.5%；作者指出，在追踪期间后面10年的衰退率更大。
此外，中风发作平均年龄在男性延后2.7岁、女性延后3.6岁；再者，研究期间的缺血性心脏病人数增加。
【造成增加的主要风险因素】
研究期间的抽烟率没有改变，其他风险因素，如肥胖和高胆固醇血症则大大增加；特别的是，整体脂肪摄取率从1983年的每天88.1 g增加到2002年的每天97.4 g。
研究者也发现平均血中胆固醇值从1984至1999年增加了24%；从1994至2002年，糖尿病流行率增加了97%，中国都会区的肥胖比率增加了13%，农村地区则是 85%。
Zhao博士表示，风险因素已经变成新的问题，且对中国的公共卫生带来挑战；他指出，缺乏卫生照护服务，特别是农村地区，仍旧是中国中风风险因素的一大障碍。
丹麦哥本哈根Bispebjerg大学医院的Thomas Truelsen博士和纽西兰奥克兰大学族群健康学院的Ruth Bonita博士在编辑评论中表示，今日在中国的风险因素问题可能在许多年后爆发，包括中风和缺血性心脏病；透过立法和积极的公共卫生政策早期预防可以降低改善中的经济所带来的潜在伤害。
该研究接受中国科技部与健康部、世界卫生组织额外基金、北京市立科技委员会专案计划等之赞助。
Stroke.线上发表于2008年2月28日摘要一 、摘要二
China's Economic Prosperity Parallels Rising Stroke Rate
By Caroline Cassels
Medscape Medical News
A rise in ischemic stroke in China is being attributed to growth in the country's economic prosperity over the past 2 decades.
A large, long-term, population-based study showed that from 1984 to 2004 the rate of ischemic stroke in China increased by almost 9%.
The study's lead author, Dong Zhao, MD, PhD, from Beijing Anzhen Hospital, in China, said these changes in China's stroke rate and stroke mortality occurred during a time of rapid economic development and growth in the country that greatly changed people's lifestyles and healthcare.
"The changes in patterns of stroke have raised new challenges and the need to adjust priorities to prevent stroke in China," said Dr. Zhao, in a statement from the American Stroke Association.
The study is published online February 28 in Stroke.
Unique Study
According to the study, previous population-based research has suggested a link between poverty and certain stroke characteristics, more hemorrhagic strokes, stroke onset at younger ages, more fatal strokes, and more deaths from stroke than from heart disease.
If this is the case, the authors note, stroke rates should decline during periods of economic prosperity. However, there has been little, if any, research that has tested this hypothesis, making this study the first of its kind.
"No previous data provided prospective and long-term trends on the incidence of stroke and case fatality rate in 1 large population of a developing country as evidence of the epidemiological transition of stroke," said Dr. Zhao, who is also chair of the Council of Epidemiology and Prevention for the World Heart Federation.
To examine the changes in trends of stroke epidemiology during a period of fast economic development in China, researchers used data from the Sino–Monitoring Trends and Determinants in Cardiovascular Disease Project (MONICA)–Beijing, which tracked incidence and mortality rates of stroke and cardiovascular events in Beijing from 1984 to 2004.
Over the study period, 14,585 strokes occurred in individuals aged 25 to 74 years. The analysis revealed an average annual 8.7% increase in ischemic stroke and an average 1.7% decrease in hemorrhagic stroke. However, the overall fatality rates decreased for both types of stroke — 1.7% for hemorrhagic stroke and 0.5% for ischemic stroke. The authors also note the rate of decline was greater during the second decade of follow-up.
In addition, the mean age of onset for stroke was delayed 2.7 years in men and 3.6 years in women. Further, the proportion of individuals with ischemic heart disease increased during the study period.
Major Risk Factors on the Rise
While rates of smoking remained relatively static during the study period, other major risk factors increased substantially, including obesity and hypercholesterolemia. In particular, total fat intake increased from 88.1 g/day in 1983 to 97.4 g/day in 2002.
The investigators also found average blood cholesterols levels increased by 24% from 1984 to 1999. From 1994 to 2002, there was a 97% increase in diabetes prevalence, and obesity in China increased by 13% in urban areas and 85% in rural regions.
"Risk factors have become a new problem and challenge for public health in China," said Dr. Zhao. He added that lack of access to healthcare services, particularly in rural areas, remains "an important barrier to treatment of risk factors for stroke in China."
In an accompanying editorial, Thomas Truelsen, MD, PhD, from the Bispebjerg University Hospital, in Copenhagen, Denmark, and Ruth Bonita, PhD, from the School of Population Health, University of Auckland, in New Zealand, warn that "it is possible that the effects of today's prevalence of risk factors in the Chinese population will reach many years into the future, not only with respect to stroke but also ischemic heart disease. Early prevention through legislation and active public health policy could reduce the potential harmful effects of an improved economy."
The study was funded by the People's Republic of China Ministry of Science and Technology and the Ministry of Health, with additional funding from the World Health Organization and a project from Beijing Municipal Science and Technology Commission.
Stroke. Published online February 28, 2008. Abstract Abstract