Cerebrovascular disease is a common and frequent disease that endangers people’s health, and is a serious disease that causes death or disability, which has attracted great attention and widespread concern from the medical community and society. From the strategy of “Health for All in the 21st Century”, the World Health Organization has proposed to strengthen the prevention and treatment program of cerebrovascular diseases, which has become the goal of global doctors. According to WHO statistics, stroke accounts for the top three causes of death in 40 out of 57 countries worldwide, and stroke related disability is estimated to be more than 6 per 1,000 people. How much money is spent each year by the state or the general public to treat cerebrovascular disease? It is estimated that during the 10 years from 2005 to 2015, the economic loss due to cerebrovascular disease in our country is $558 billion, accounting for one-fifth to one-fourth of the national health care investment, and stroke brings a heavy burden to patients, families and society. Du Quanyue, Department of Neurology, Baicheng Central Hospital
1 So what is cerebrovascular disease?
Cerebrovascular disease is a brain dysfunction caused by lesions in the blood vessels of the brain. The clinical manifestations are focal symptoms and signs, often with sudden fainting, coma, or with distorted mouth and eyes, slurred speech and hemiplegic aphasia. Commonly, such as cerebral hemorrhage, cerebral thrombosis,, subarachnoid hemorrhage, transient ischemic attack and so on.
2 What are the characteristics of cerebrovascular diseases in China?
①According to current statistics, there are 1.5 million new cases and about 1 million deaths each year in China ②More men than women ③There is a trend of higher incidence in the north and lower incidence in the south, with the eastern coast being higher than the western plateau.
3 How to identify cerebrovascular disease at an early stage and what should the public do if they find it?
The public should have an understanding of the common manifestations of cerebrovascular diseases. I will talk about the common symptoms.
(1) Sudden onset of cerebrovascular disease symptoms. (2) Weakness, clumsiness, heaviness or numbness in one limb (with or without the face). (3) Numbness of one side of the face or distortion of the corners of the mouth. (4) Slurred speech or difficulty understanding speech. (5) Gaze to one side with both eyes. (6) Loss or blurring of vision in one or both eyes. (7) Rotation of vision or balance disturbance. (8) Severe headache and vomiting, which were previously rare. (9) The above symptoms with impaired consciousness or convulsions.
My recommendation is that when a person with risk factors for stroke (e.g. hypertension, heart disease, diabetes, etc.) suddenly develops the above-mentioned manifestations or suddenly becomes confused and unconscious, he or she should also be aware of the possibility of stroke and be taken to the hospital immediately. In the pre-hospital stage, the diagnosis and classification of stroke is not yet clear, so it is a priority to send the patient to the nearest hospital with examination and treatment as soon as possible for timely diagnosis and treatment. Such hospitals must be able to perform emergency CT examinations, have stroke specialists with 24-hour follow-up, and be able to perform thrombolysis and craniotomy. During transport, the patient should generally be placed in a flat position, and the limbs should be kept in a functional position to protect the airway. However, if the patient has agitation or onset during exercise, headache, vomiting, neck resistance and other manifestations, cerebral hemorrhage is more likely, appropriate antihypertensive measures can be taken.
4 How to prevent the occurrence of cerebrovascular diseases? The fundamental measure to reduce the incidence, prevalence and death rate of cerebrovascular diseases is prevention. We should actively carry out prevention and treatment before, at and after the onset of the disease. First, prevention of morbidity, comprehensive control of various risk factors, early interruption of disease; second, prevention of events, stabilization of arterial plaque, anti-platelet aggregation and anticoagulation, prevention of stroke; third, prevention of consequences, take active and reasonable treatment, reduce cerebrovascular disease comorbidities, reduce sequelae. Fourth, prevention of recurrence, after the patient is rescued, secondary prevention should be done to minimize the risk factors of cerebrovascular disease and prevent recurrence.
What should we do? People over 35 years old who do not have cerebrovascular disease should know the following: ①Know your blood pressure, high blood pressure is an independent risk factor for cerebrovascular disease, measure blood pressure at least once a year. ② Whether you have heart disease, especially atrial fibrillation. ③ Quit smoking and drink alcohol moderately. Smoking doubles the risk of stroke. ④Know if you have hyperlipidemia and diabetes. ⑤ Participate in your favorite sports activities regularly in your daily life
5 How are cerebrovascular diseases classified?
There are many ways to classify cerebrovascular disease. Ischemic strokes include cerebral infarction, including cerebral thrombosis and cerebral embolism, and transient ischemic attack. Hemorrhagic includes cerebral hemorrhage and subarachnoid hemorrhage.
6 What is the pathogenesis or principle of ischemic cerebrovascular disease?
(1) Arterial wall lesion: It is the key factor of cerebral thrombosis. If there is no abnormality in the arterial wall, it is usually not easy to lead to cerebral thrombosis, such as patients in shock, no matter how long the shock time is, cerebral thrombosis usually does not occur.
(2) Blood component changes: On the basis of arterial wall lesions, blood component changes, increased blood viscosity, increased red blood cell excess, hyperlipidemia and increased fibrinogen can promote thrombosis.
(3) Hemodynamic abnormalities: clinically common cerebral infarction patients develop during sleep at night, which may lead to blood pressure drop and slow blood flow after sleep, and may lead to thrombus formation in the lesion part on the basis of arterial wall lesions.
Risk factors for cerebrovascular disease can be divided into intervenable and non-intervenable factors.
Non-interferable factors include age, gender, race, genetic factors, climate, etc.
Interventional factors include hypertension, heart disease, hyperglycemia, dyslipidemia, poor lifestyle (e.g., smoking, heavy alcohol consumption, high salt and fat diet, bad mood, etc.), carotid artery stenosis, hyperhomocysteinemia, hyperfibrinogenemia, drugs, etc. They are the main targets of cerebrovascular disease risk factor prevention and are called primary prevention, also known as etiological prevention or radical prevention.
7 I am going to talk about non-interventional factors specifically
The relationship between age and cerebrovascular disease
Age is a non-interventional factor, and the older the age, the greater the chance of cerebrovascular disease. The older the age, the more risk factors for cerebrovascular disease, the heavier the degree of atherosclerosis, and the higher the incidence of cerebrovascular disease; the incidence increases by more than a factor of 10 for every 10 years after age 55, and stroke prevention and control should be a priority over age 50.
What are the reasons for this?
(1) Hypertension, hyperlipidemia, and hyperviscosity: these three diseases often exist in combination and are mutually beneficial, and together they aggravate the damage to blood vessels, and there are often no obvious symptoms in the early stage. (2) Do not take the disease seriously: here are three cases, one is not to see a doctor even if you feel unwell, and hold on; second, even if you see a doctor and have a clear diagnosis, you do not take the doctor’s advice seriously, thinking that you are young and healthy, busy with work and do not have time to treat the disease, so you can drag it out; third, even if you take medicine, you cannot take it regularly, and often fish for three days and sunbathe for two days. (3) work tension, psychological pressure: young people is a period of entrepreneurship or career advancement, no matter what kind of position are facing the competition pressure, workload, psychological long-term in a high state of tension, in the long run caused by headaches, dizziness, fatigue, insomnia, anxiety, irritability, work efficiency decline. (4) excessive drinking, overeating, nutritional imbalance: young people have more interactions, more socializing, drinking does not stay, too much fat, vitamin intake is insufficient, most have obesity. (5) less exercise: too much calorie intake, too little exercise, low energy consumption, aggravating hyperlipidemia, hypertension, hyperviscosity. (6) Smoking: Carbon monoxide in smoke can damage vascular endothelial cells, increase vascular permeability, accelerate atherosclerosis, and increase the risk of stroke. (7) Irregularity of life: Due to their work, they often do not have three meals a day on time, and often work overtime and do not get enough sleep. (8) Genetic factors: Family history of hypertension, diabetes, hyperlipidemia and stroke. Therefore, in addition to the elderly, young and middle-aged people should also pay attention to the prevention of cerebrovascular disease prevention.
2.The relationship between gender and cerebrovascular disease
There are more men than women for the following reasons.
(1) Men have more hypertension than women. (2) Men smoke and drink more alcohol than women. The incidence of cerebrovascular disease in smokers is high, and is positively related to the amount of daily smoking and the duration of smoking. (3) Men are engaged in heavy physical labor, sudden exertion will induce cerebrovascular disease. (4) Individual men are irritable or too depressed, these are the triggering factors of cerebrovascular disease. 3, the relationship between race and cerebrovascular disease
The incidence of cerebrovascular disease and mortality rates vary greatly among different races, and the incidence of cerebrovascular disease in blacks is 4-5 times higher than that in whites. The incidence of cerebrovascular disease is higher in Asian countries such as China and Japan. It may be related to living conditions and literacy as well as the degree of education.
4.The relationship between heredity and cerebrovascular disease
Cerebrovascular disease has a clear genetic predisposition. It has been reported that the incidence of cerebrovascular disease is significantly higher in close relatives whose brothers and sisters have cerebrovascular disease than in normal people. Other data show that the incidence of cerebrovascular disease is four times higher in people with cerebrovascular disease in the paternal and maternal lines than in the general population. All these fully illustrate that cerebrovascular disease and genetic factors, therefore, people with genetic predisposition should be prevented as early as possible.
5, the relationship between climate and cerebrovascular disease
There is a correlation between the occurrence of cerebrovascular disease and the seasons. Cerebral thrombosis occurs more often in June and July because the weather has just turned warm, blood vessels expand, blood pressure drops, or blood viscosity increases due to sweating and dehydration, which triggers cerebral thrombosis. Especially for elderly patients with hypertension, sudden changes in temperature can easily trigger cerebrovascular disease. Late autumn and early winter is an important period for triggering cerebral hemorrhage, and the sudden change of climate has a great relationship. The reasons are (1) Low temperature can make the elasticity of body surface blood vessels decrease, peripheral resistance increases, and blood pressure rises, which in turn leads to cerebrovascular rupture and bleeding. (2) Cold stimulation can also cause sympathetic excitation, increased secretion of adrenocorticotropic hormone, which causes small arteries to contract spasmodically, increasing peripheral resistance and increasing blood pressure. Therefore, people who are prone to cerebrovascular disease should pay special attention to climate changes, add and remove clothes at the right time to protect their health and prevent cerebrovascular disease.
We have talked about non-interventional factors above, and we will focus on interventional factors below. We can reduce the incidence, disability and mortality of cerebrovascular disease by carefully intervening in interventional factors.
8 Interventional factors
The relationship between hypertension and cerebrovascular disease
When systolic blood pressure exceeds 140 mmHg and diastolic exceeds 90 mmHg in adults, it is called hypertension. Hypertension is divided into two cases, one is because the blood pressure is raised by other diseases, called secondary hypertension, for example: kidney disease, certain endocrine diseases, blood vessel stenosis, etc. can lead to increased blood pressure, this type of hypertension is also known as symptomatic hypertension. For the former, the main root cause is the primary disease, and if the primary disease is treated, the blood pressure will improve. What we are discussing here is mainly the latter —— primary hypertension. When suffering from hypertension, some people can be asymptomatic, but they may also experience dizziness, headache, headache, irritability, irritability, weakness of both lower limbs and redness of the face, or they may be asymptomatic because they have been accustomed to it for a long time.
Hypertension is the most important risk factor for cerebrovascular disease, and the risk of cerebrovascular disease can be reduced by controlling hypertension. Several large-scale multicenter randomized controlled clinical studies at home and abroad have shown that active treatment of hypertension can reduce the first occurrence of cerebrovascular disease in hypertensive patients. For every 5-10 mmHg decrease in systolic blood pressure or 2-5 mmHg decrease in diastolic blood pressure, the risk of cerebrovascular disease is reduced by 30% to 40%. For patients with cerebrovascular disease, antihypertensive treatment is also very important for secondary prevention of cerebrovascular disease, and the risk of recurrence of cerebrovascular disease can be reduced by appropriately lowering the blood pressure level.
In China, it is estimated that there are more than 160 million hypertensive patients, and the chance of cerebrovascular disease in asymptomatic hypertension is 4 times higher than in normotensive patients, and 10 times higher in those with symptoms that are untreated or poorly treated than in those who are well treated, and it is also found in the study that the risk of cerebrovascular disease is great whether the systolic or diastolic blood pressure is elevated, and that cerebrovascular disease occurs in 70% of hypertensive patients. Therefore, we say that hypertension is the primary and most important risk factor for cerebrovascular disease, and the prevention and treatment of hypertension is the top priority.
China’s hypertension currently has “three high and three low”, high prevalence, high risk, high growth trend; low awareness rate, low treatment rate, low control rate. According to statistics, the awareness rate of hypertension in China is 30%, the treatment rate is 25%, the control rate is 6%, and about 110 million people in the country do not know they have hypertension. About 75% of hypertensive patients do not undergo regular antihypertensive treatment, and 94% of hypertensive patients fail to meet the blood pressure standard (i.e., blood pressure is still greater than 140/90 mmHg). Because the rate of hypertension awareness, treatment and control is so low in China, the blood pressure level of 150 million hypertensive patients is in a state of hypertension, which becomes a huge reserve army for the occurrence of cerebrovascular disease. Therefore, let the people of the country know whether they have hypertension, and if they have hypertension, they should adhere to long-term regular treatment and make clear that the goal of blood pressure reduction is blood pressure