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      Stroke: Morbidity, Risk Factors, and Care in Taiwan

      review-article
      ,
      Journal of Stroke
      Korean Stroke Society
      Stroke, Risk factors, Morbidity, Stroke care, Taiwan

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          Abstract

          Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.

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          Most cited references32

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          Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship.

          The objective was to study the relationship between body mass index (BMI) and body fat per cent (BF%) in different population groups of Asians. The study design was a literature overview with special attention to recent Asian data. Specific information is provided on Indonesians (Malays and Chinese ancestry), Singaporean Chinese, Malays and Indians, and Hong Kong Chinese. The BMI was calculated from weight and height and the BF% was determined by deuterium oxide dilution, a chemical-for-compartment model, or dual-energy X-ray absorptiometry. All Asian populations studied had a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI their BF% was 3-5% points higher compared to Caucasians. For the same BF% their BMI was 3-4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk-to-leg-length ratio and differences in slenderness. Differences in muscularity may also contribute to the different BF%/BMI relationship. Hence, the relationship between BF% and BMI is ethnic-specific. For comparisons of obesity prevalence between ethnic groups, universal BMI cut-off points are not appropriate.
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            Discovery, biochemistry and biology of lovastatin.

            Cholesterol is a 27-carbon steroid that is an essential component of the cell membrane, the immediate precursor of steroid hormones, the substrate for the formation of bile acids, and is required for the assembly of very low density lipoprotein in the liver. Because as much as two-thirds of total body cholesterol in patients is of endogenous origin, an effective means to control cholesterogenesis may occur by inhibition of its biosynthesis. Cholesterol is biosynthesized in a series of more than 25 separate enzymatic reactions that initially involve the formation of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA). Early attempts to pharmacologically block cholesterol synthesis focused only on steps later in the biosynthetic pathway and resulted in compounds with unacceptable toxicity. Recent research had identified that HMG CoA reductase is a key rate-limiting enzyme in this pathway and is responsible for the conversion of HMG CoA to mevalonate. Additional research with fungal metabolites identified a series of compounds with potent inhibiting properties for this target enzyme, from which lovastatin was selected for clinical development. A reduction in cholesterol synthesis by lovastatin has been subsequently confirmed in cell culture, animal studies and in humans. A resultant decrease in circulating total and low-density lipoprotein (LDL) cholesterol has also been demonstrated in animals and humans. Because hepatic LDL receptors are the major mechanism of LDL clearance from the circulation, further animal research has confirmed that these declines in cholesterol are accompanied by an increase in hepatic LDL receptor activity. Lovastatin effectively diminishes endogenous cholesterol synthesis providing useful therapeutic properties for patients with hypercholesterolemia.
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              Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese.

              We investigated atrial fibrillation (AF) prevalence, incidence and the risk of stroke and all-cause death because little is known about AF risk among ethnic Chinese. We conducted a community-based prospective cohort study among 3560 participants. Prevalent and incident AF was documented by using the 12-lead ECG in baseline and serial follow-ups, and the stroke and all-cause death events were ascertained. Overall prevalence rates of AF in the cohort were 1.4% in men and 0.7% in women. Incidence rates of AF were 1.68 per 1000 person-years for men and 0.76 per 1000 person-years for women. During a median 13.8 years' follow-up, we documented 208 cases of stroke and 776 deaths. As compared with those without AF, participants with AF had nearly 4 times the age, gender-adjusted risk of stroke (relative risk [RR], 3.87, 95% confidence interval [CI], 2.12-7.15), and twice the risk of death associated with all causes (RR, 2.23, 95% CI, 1.52-3.27). Further adjustment for body mass index, lifestyle factors, socioeconomic status and clinical diseases slightly attenuated these risks. In addition, after adjusting for echocardiographic measures, the following risks remained significant: the multivariate RRs were 2.90 (95% CI, 1.28-6.59) for risk of stroke and 2.05 (95% CI, 1.27-3.32) for risk of all-cause death among participants with AF. Our data demonstrate that AF is a significant risk factor for stroke and all-cause death for the Chinese. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Journal
                J Stroke
                J Stroke
                JOS
                Journal of Stroke
                Korean Stroke Society
                2287-6391
                2287-6405
                May 2014
                30 May 2014
                : 16
                : 2
                : 59-64
                Affiliations
                School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
                Author notes
                Correspondence: Hung-Yi Chiou. School of Public Health, College of Public Health and Nutrition, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei 110, Taiwan. Tel: +886-2-23779188, Fax: +886-2-23779189, hychiou@ 123456tmu.edu.tw
                Article
                10.5853/jos.2014.16.2.59
                4060269
                24949310
                0c1a334c-49b0-458c-b900-9faa5eb7d16a
                Copyright © 2014 Korean Stroke Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 May 2014
                : 19 May 2014
                : 20 May 2014
                Categories
                Review

                stroke,risk factors,morbidity,stroke care,taiwan
                stroke, risk factors, morbidity, stroke care, taiwan

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