Non-traditional lipid profiles and the risk of stroke: A systematic review and meta-analysis

AimsAn increasing number of studies on non-traditional lipid profiles have been investigated in recent years. However, the associations between non-traditional lipid profiles and the risk of stroke remained inconsistent. Therefore, this meta-analysis aimed to evaluate the associations between non-traditional lipid profiles and the risk of stroke and clarify the dose–response relations.Data synthesisWe performed a systematic literature search in PubMed, Embase, and Web of Science databases until 1 November 2022 for relevant studies. Relative risks and 95% confidence intervals were pooled by random-effects or fixed-effects models. A total of 26 full-text studies with 676678 participants and 18057 stroke cases were eligible for the final study. We found a positive association between the risk of stroke and total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio (RR = 1.19,95%CI = 1.00–1.40, I² = 74.6%), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio (RR = 1.24,95%CI = 1.10–1.41, I² = 62.8%) or low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio (RR = 1.24, 95%CI = 1.11–1.39, I² = 49.4%). When focusing on the stroke subtype, a more significant association was observed between the risk of ischemic stroke and four non-traditional lipid profiles. In dose–response analysis, we found a linear association between TC/HDL-C ratio and the risk of stroke (RR = 1.16,95%CI = 1.07–1.26).ConclusionsElevated non-traditional lipid profiles were associated with an increased risk of ischemic stroke. The linear association showed the risk of stroke increased by 16% when the pooled RR of TC/HDL-C ratio per 1-unit increased.Registration number in prosperoCRD42022321251.     

Dairy foods and risk of stroke: A meta-analysis of prospective cohort studies

Background and aimsEpidemiological studies evaluating the association of dairy foods with risk of stroke have produced inconsistent results. We conducted a meta-analysis to summarize the evidence from prospective cohort studies regarding the association between dairy foods and risk of stroke.Methods and resultsPertinent studies were identified by searching Embase (1950–November, 2013), Web of Knowledge (1950–November, 2013) and Pubmed (1945–November, 2013). Random-effect model was used to combine the results. Dose–response relationship was assessed by restricted cubic spline. Eighteen separate results from fifteen prospective cohort studies, with 28 138 stroke events among 764 635 participants, were included. Total dairy [relative risk (95% CI): 0.88 (0.82–0.94)], low-fat dairy [0.91 (0.85–0.97)], fermented milk [0.80 (0.71–0.89)] and cheese [0.94 (0.89–0.995)] were significantly associated with reduced risk of stroke, but whole/high-fat dairy, nonfermented milk, butter and cream were not significantly associated with risk of stroke. Stronger association was found for stroke mortality than incidence, and for studies conducted in Asia than Europe, while the association did not differ significantly by sex. Limited data did not find any significant association with either ischemic or hemorrhagic stroke. A non-linear dose–response relationship (P = 2.80*10⁻¹³) between milk and risk of stroke was found, and the relative risk of stroke was 0.88 (0.86–0.91), 0.82 (0.79–0.86), 0.83 (0.79–0.86), 0.85 (0.81–0.89), 0.86 (0.82–0.91), 0.91 (0.84–0.98) and 0.94 (0.86–1.02) for 100, 200, 300, 400, 500, 600 and 700 ml/day of milk, respectively.ConclusionsDairy foods might be inversely associated with the risk of stroke.     

Consumption of nuts and legumes and risk of stroke: A meta-analysis of prospective cohort studies

Background and aimThe relationships between dietary nuts and legume intake and risk of stroke are inconsistent. We summarized the evidence by a meta-analysis of prospective cohort studies.Methods and resultsWe systematically searched the MEDLINE and EMBASE databases up to 31 January 2014. Random-effects models were used to calculate summary relative risks (SRRs) and 95% confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran's Q and I² statistics.Eight prospective studies with a total of 468,887 subjects and 10,493 stroke events were included in the meta-analysis. Overall, a diet containing greater amounts of legumes may be not associated with a lower risk of stroke (SRR = 0.95, 95% CI: 0.84–1.08; P_{heterogeneity} = 0.091, I² = 43.2%); however, a diet containing greater amounts of nuts may be associated with a lower risk of stroke (SRR = 0.90, 95% CI: 0.81–0.99; P_{heterogeneity} = 0.527, I² = 0). Gender significantly modified the effects of nut consumption on stroke risk, and high nut intake was associated with reduced risk of stroke in women (SRR = 0.85, 95% CI: 0.75–0.97) other than in men (SRR = 0.95, 95% CI: 0.82–1.11).ConclusionThe current meta-analysis provides some evidences for the hypothesis that high intake of dietary nut was inversely associated with stroke risk, whereas dietary legumes intake was not associated with stroke risk.     

甲状腺功能亢进症与卒中发病相关性：一项基于前瞻性队列研究的Meta分析

目的探讨甲状腺功能亢进症（HT）与卒中发病的相关性。 方法中文以"甲状腺功能亢进症" "卒中" "脑梗死" ,英文以"thyroid dysfunction" "thyroid disorder" "thyroid disease" "hyperthyroidism" "thyrotoxicosis" "stroke" "cerebrovascular disease" "cerebrovascular accident"为检索词。计算机检索Pubmed、EMbase、Google Scholar、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数字化期刊全文数据库,并手工检索相关杂志。由2位研究者按照纳入和排除标准筛选文献,并进行资料提取,当意见不统一时,交由第3位研究者决定。采用Newcastle-Ottawa Scale（NOS）文献质量评价量表对符合纳入标准的文献进行质量评价,并采用Stata 12.0软件对纳入文献的结局指标进行Meta分析。 结果共纳入11项前瞻性队列研究,NOS量表评分提示均为质量较高文献。Meta分析结果表明：HT患者发生卒中的风险是甲状腺功能正常（ET）人群的1.30倍（P<0.05）。亚组分析结果表明,亚洲地区的HT患者发生卒中的风险是亚洲ET人群的1.39倍（P<0.05);甲亢类型属于临床HT的患者发生卒中的风险是ET人群的1.32倍（P<0.05）;不伴有心房颤动的HT患者发生卒中的风险是ET人群的1.33倍（P<0.05)。对校正了大多数混杂因素的研究进行的亚组分析表明,HT患者发生卒中的风险是ET人群的1.35倍（P<0.05)。Begg和Egger检验均表明无发表偏倚可能,剪补法校正后RR为1.26。敏感性分析提示本次研究结果稳定。 结论HT可能为卒中发病的一个危险因素,鉴于本研究的局限性,需要进一步开展相关研究进行验证。     

Tobacco smoking and the risk of pancreatitis: A systematic review and meta-analysis of prospective studies

BackgroundTobacco smoking has been associated with increased risk of pancreatitis in several studies, however, not all studies have found an association and it is unclear whether there is a dose-response relationship between increasing amount of tobacco smoked and pancreatitis risk. We conducted a systematic review and meta-analysis of prospective studies on tobacco smoking and pancreatitis to clarify the association.MethodsPubMed and Embase databases were searched for relevant studies up to April 13th^, 2019. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between tobacco smoking and pancreatitis were included and summary RRs were calculated using a random effects model.ResultsTen prospective studies were included. The summary RR for acute pancreatitis was 1.49 (95% CI: 1.29–1.72, I² = 68%, n = 7) for current smokers, 1.24 (95% CI: 1.15–1.34, I² = 0%, n = 7) for former smokers, and 1.39 (95% CI: 1.25–1.54, I² = 69%, n = 7) for ever smokers compared to never smokers. Similar results were observed for chronic pancreatitis and acute/chronic pancreatitis combined. The summary RR per 10 cigarettes per day was 1.30 (95% CI: 1.18–1.42, I² = 42%, n = 3) and per 10 pack-years in current smokers was 1.13 (95% CI: 1.08–1.17, I² = 14%, n = 4) for acute pancreatitis and results were similar for chronic pancreatitis and acute/chronic pancreatitis combined.ConclusionsThese results suggest that tobacco smoking increases the risk of acute and chronic pancreatitis and acute and chronic pancreatitis combined and that there is a dose-response relationship between increasing number of cigarettes and pack-years and pancreatitis risk.     

Risk of ischemic stroke in patients with systemic sclerosis: A systematic review and meta-analysis

Background. Several chronic inflammatory disorders, such as rheumatoid arthritis and idiopathic inflammatory myositis, have been shown to increase risk of ischemic stroke but the data on systemic sclerosis (SSc) remains unclear.

Methods. We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing risk of ischemic stroke in patients with SSc versus non-SSc participants. Pooled risk ratio and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.

Results. Four retrospective cohort studies were identified and included in our data analysis. We found a statistically significant elevated ischemic stroke risk in patients with SSc with a pooled risk ratio of 1.68 (95% CI, 1.26–2.24). The statistical heterogeneity was moderate with an I² of 69%.

Conclusions. Our study demonstrated a statistically significant increased ischemic stroke risk among patients with SSc.     

Diabetes mellitus and the risk of sudden cardiac death: A systematic review and meta-analysis of prospective studies

Background

Although diabetes mellitus is an established risk factor for myocardial infarction and stroke, data on the association with sudden cardiac death are less extensive and the findings have not been entirely consistent. We therefore conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and risk of sudden cardiac death.

Homocysteine level and risk of different stroke types: A meta-analysis of prospective observational studies

Background and aimsInconsistent findings have been reported regarding the association between elevated plasma homocysteine (Hcy) levels and the risk of different types of strokes. We conducted this meta-analysis to identify the association between homocysteine (Hcy) levels and different kinds of strokes or recurrences of strokes.Methods and resultsPubMed and Embase databases were searched for relevant studies published prior to April 2013. Only prospective studies that compared elevated Hcy levels with the risk of different types of strokes were selected. Results were presented as the relative risk (RR) and the corresponding 95% confidence intervals (CI) comparing the highest Hcy category group with the lowest Hcy category group. Nine studies composed of 13,284 participants were included. The pooled RR of ischemic strokes when comparing the highest Hcy category group with the lowest Hcy category group was 1.69 (95% CI: 1.29–2.20) in a fixed-effect model. The pooled RR of hemorrhagic strokes and recurrent strokes when comparing the highest Hcy category group with the lowest Hcy category group in a fixed-effect model was 1.65 (95% CI: 0.61–4.45) and 1.76 (95% CI: 1.37–2.24), respectively.ConclusionsThis meta-analysis indicated that elevated Hcy levels are associated with an increased risk for ischemic strokes and recurrent strokes but had no distinct association with hemorrhagic strokes.     

Potassium-rich diet and risk of stroke: Updated meta-analysis

Recently a few prospective population studies provided additional and heterogeneous information concerning the reported statistical associations between potassium (K) intake and stroke risk. Therefore, we updated our previous meta-analysis of K intake and risk of cerebrovascular events.Three studies were added to the previous analysis, and the results of the comparison between the event rate in the two extreme categories of K intake were used. Pooled analysis of 14 cohorts (overall 333,250 participants and 10,659 events) showed an inverse and significant association between K intake and risk of stroke (Relative Risk: 0.80; 95% CI: 0.72–0.90).Our results indicated a favorable effect of higher K intake on risk of stroke. These results confirm the appropriateness of worldwide recommendations for a population increased consumption of potassium-rich foods to prevent cardiovascular disease.     

Diabetes mellitus and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies

Background

Diabetes mellitus has been associated with reduced risk of abdominal aortic aneurysm in a number of epidemiological studies, however, until recently little data from prospective studies have been available. We therefore conducted a systematic review and meta-analysis of prospective studies to quantify the association.

Multimorbidity and mortality in older adults: A systematic review and meta-analysis

ObjectiveTo review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults.MethodsA systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression were performed to evaluate sources of heterogeneity.ResultsOut of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55)] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behaviour variables. Disabilities appear to mediate the effect of multimorbidity on mortality.ConclusionsMultimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.     

高尿酸血症与缺血性卒中及其危险因素

高尿酸血症与高血压、糖尿病、高脂血症、肥胖等卒中危险因素均有显著相关性,且与缺血性卒中及其预后相关.文章对高尿酸血症与卒中危险因素的相关性及其对缺血性卒中预后的影响进行了综述.     

Diabetes mellitus,blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies

Background and Aim

The strength of the association between diabetes and risk of heart failure has differed between previous studies and the available studies have not been summarized in a meta-analysis. We therefore quantified the association between diabetes and blood glucose and heart failure in a systematic review and meta-analysis.

Hemodialysis and risk of acute pancreatitis: A systematic review and meta-analysis

BackgroundEpidemiological evidence indicates that hemodialysis may be a risk factor for acute pancreatitis. This meta-analysis was conducted with the aim of summarizing all available data and examining the present evidence.AimTo quantify the association between hemodialysis and the incidence of acute pancreatitis.MethodsThis meta-analysis included studies on the incidence of acute pancreatitis in patients with hemodialysis. We summarized the incidence of acute pancreatitis in hemodialysis patients, and compared the incidence of acute pancreatitis in hemodialysis patients with that in non-hemodialysis individuals. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.ResultsA total of 5 observational studies with 1059384 individuals were identified for the meta-analysis. Meta-analysis of these observational studies showed that the pooled prevalence of acute pancreatitis in hemodialysis patients was 1.1% (95% CI: 0.2%–2.3%). In addition, we found that hemodialysis was associated with an increased risk of acute pancreatitis (relative risk = 6.96; 95% CI 3.71–13.06).ConclusionThis meta-analysis confirmed that hemodialysis is associated with an increased risk of acute pancreatitis. More fundamental research should be carried out to elucidate the biological mechanisms.     

Diabetes mellitus and the risk of pancreatitis: A systematic review and meta-analysis of cohort studies

BackgroundDiabetes mellitus has been associated with increased risk of pancreatitis in several studies, however, not all studies have found an association. We conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and pancreatitis to clarify the association.MethodsPubMed and Embase databases were searched for studies on diabetes mellitus and pancreatitis up to 8^th of January 2020. Cohort studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between diabetes diagnosis and pancreatitis were included and summary RRs (95% CIs) were calculated using a random effects model.ResultsEight cohort studies were included in the meta-analysis, and seven of these were included in the analysis of diabetes mellitus and acute pancreatitis (14124 cases, 5.7 million participants). Comparing diabetes patients with persons without diabetes the summary RRs (95% CIs) were 1.74 (95% CI: 1.33–2.29, I² = 95%) for acute pancreatitis, 1.40 (95% CI: 0.88–2.22, I² = 0%, n = 2) for chronic pancreatitis, and 1.39 (95% CI: 1.07–1.80, I² = 54%, n = 3) for pancreatitis overall. Although there was some indication of publication bias in the analysis of acute pancreatitis this appeared to be explained by one outlying study which when excluded did not substantially alter the association. The results persisted in several subgroup and sensitivity analyses.ConclusionsThese results suggest that diabetes patients are at an increased risk of acute pancreatitis. Further studies are needed on diabetes and risk of chronic pancreatitis, pancreatitis overall and on gallstone-related and non-gallstone-related pancreatitis.     

Postoperative delirium after hip surgery is a potential risk factor for incident dementia: A systematic review and meta-analysis of prospective studies

BackgroundAlthough a few trials have explored the relationship between postoperative delirium (POD) and incident dementia in patients with hip surgery, the numbers of participants in each study are relatively small. Thus, we performed a meta-analysis to examine whether POD after hip surgery is a risk factor for incident dementia.MethodsSix prospective cohort studies investigating the development of incident dementia in patients with POD after hip surgery were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- and random- effect models.ResultsPOD significantly increased the risk of incident dementia and cognitive decline (overall odds ratio [ORs] = 8.957; 95 % confidence interval [CI], 5.444–14.737; P < 0.001 in fixed-effects model; overall ORs = 8.962; 95 % CI, 5.344–15.029; P < 0.001 in random-effects model). A publication bias was not evident in this study.ConclusionsOur meta-analysis revealed that POD after hip surgery is a risk factor for incident dementia. Early identification of cognitive function should be needed after surgery and appropriate prevention and treatment for dementia will be required, especially in cases with POD.     

Water intake and risk of type 2 diabetes: A systematic review and meta-analysis of observational studies

Background and aimsThe association of water intake with type 2 diabetes mellitus (T2DM) is still unclear. Therefore, the aim of this systematic review and meta-analysis was to synthesize the knowledge about the relationship between water intake and the risk of T2DM.MethodsWe conducted a systematic search in PubMed and Scopus up to June 2018 for observational studies. Risk ratios (RR)s and 95% confidence intervals (95% CI)s were calculated and fixed effects models were used.ResultsOverall, 6 studies were included in the meta-analyses. There was an inverse relationship between water intake and risk of T2DM (RR: 0.94; 95% CI: 0.91–0.97, P < 0.001) with low heterogeneity (I2 = 24%, P = 0.24).ConclusionOur findings indicated that the intake of water was correlated with reduced risk of type 2 diabetes in women and men. These results support the current recommendations of water intake as an inseparable part of a diet with the lowest risk of diabetes mellitus.