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Unless China can control growing rates of hypertension, strokes will remain the country's number one killer disease, warned a group of international scientists gathered in Beijing for a November medical forum sponsored by The Lancet. |
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What's more, cases of ischemic stroke are on the rise: In the last two decades, the number of ischemic stroke cases in China increased annually by an average of 8.7 percent, according to a research team led by Zhao Dong, of the Beijing Anzhen Hospital. Zhao and his team published their study in the February issue of the Journal of the American College of Cardiology.
"The situation [of growing stroke cases] may be worse in the future as we see a considerably enlarging prevalence of risk factors leading to stroke," said Wu Yangfeng, a leading cardiologist at Peking University's medical school who spoke at the forum.
Wu was referring to growing rates of hypertension, diabetes, obesity, smoking and drinking, all associated with China's booming economy. "These are all confirmed risk factors for stroke, and they are prevailing much faster among younger generations," he said.
Among them, hypertension is considered the primary factor for stroke.
People with hypertension or elevated homocysteine levels are three to four times likelier than those without to suffer a stroke, according to an October study conducted by Peking University No.1 Hospital and Anhui Medical College. For people with both high blood pressure and elevated homocysteine levels, that risk is 11 times higher.
Too much homocysteine, an intermediate product of an amino acid produced during metabolism, can damage endothelial cells and escalate blood coagulation, sometimes forming blood clots.
A 2006 Chinese Ministry of Health report on cardiovascular disease showed that China had about 200 million cases of hypertension, of which 75 percent were accompanied with high homocysteine levels.
"In the 1940s, we had identified only 5 percent of hypertension cases, but today we have identified about 20 percent," said Wu, also director of the George Center in Beijing. "And only 5 to 6 percent of these patients are currently receiving regular treatment and have their disease under control."
Cases of diabetes and obesity are also on the upswing. From 1994 to 2002, diabetes cases in China soared by 97 percent, while obesity grew by 13 percent in urban areas and 85 percent in rural regions, according to Zhao's study.
Zhao's research also indicated that despite the increase in ischemic stroke cases, the number of hemorrhagic stroke cases has actually gone down, and, over the last eight years, stroke mortality in China has declined.
Wu attributes the decline to improvements in diagnostic technologies such as CT scanning, and the increased application of those technologies. This may also explain another curious factor in China's rising stroke burden: the rapid increase in risk factors indicates that China should actually have more cases of stroke than it actually has.
"[This] also alerts us that there are more risk factors that haven't been known yet," Wu said.
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The application of acupuncture to treat strokes has a history of thousands of years. Photo by Bre Pettis |
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A majority of Chinese hospitals have adapted Western therapies, such as thrombolytic therapy, to treat stroke patients. But many also use traditional Chinese medicine (TCM) to achieve better efficacy.
Liu Ming, a leading professor at the Stroke Clinical Research Unit of West China Hospital at Sichuan University, said traditional Chinese medicine in pills, capsules and injections has been widely used for stroke treatment since the mid-1980s. The application of acupuncture to treat strokes has a history of thousands of years.
"Some studies, including ours, show that 70 to 80 percent of Chinese stroke patients are adapting Chinese traditional patent medicine," she said. "Generally, Chinese people have persistently good faith in our traditional treatment, even though it may have some side effects."
The professor, who also spoke at the Lancet forum, said animal research, lab studies and clinical research have proven that TCM is effective in stroke treatment. For a disease as complicated as stroke, only one treatment plan is never enough, Liu noted, adding that more clinical research is underway.
More new therapies are under study. Last year, a group of Chinese and American scientists published an article in The Lancet, pointing out the potential of folacin supplements to reduce homocysteine levels. The group said oral folic acid supplements can reduce homocysteine levels by more than 20 percent, bringing down the risk of stroke by as much as 25 percent.
Other pioneering studies include research exploring genetic and environmental causes for stroke, stem cell transplantation treatment and neural protection therapy, which tries to improve damaged cerebral cells' ability to endure oxygen deficit.
Nevertheless, Chinese medical practitioners agree that early intervention to curb hypertension and high homocysteine levels is the best way right now for China to control its stroke epidemic.
However, even this approach still faces considerable challenges.
Wu pointed out that the general public in China has limited access to the vast body of prevention knowledge available. "How to instill the knowledge into the population, particularly that of rural areas, is a priority task," he said.
Zhao added that the lack of good medical facilities in rural regions also impedes stroke prevention in China.
Wang Wenzhi, director of the National Committee on the Prevention of Cerebral Vascular Diseases, said at the forum that the rate of stroke mortality is higher in rural areas as opposed to urban areas. He added that primary health care workers at the community level should be on the frontline of stroke prevention.
Last month, the largest-scale clinical trial for stroke prevention in China was launched. The trial, conducted by 300 hospitals nationwide, will include 15,000 hypertension patients in a four-year tracing experiment. The double-blinded study will compare the efficacy of single therapy versus combined therapy strategies.
Scientists said this study is "significant" in providing authoritative medical evidence to address the high incidence of stroke in China.
Wu Chong is a freelance journalist who has written for China Daily and SciDev.net. She is also an editor for Global Environmental Review, a Chinese electronic magazine about environmental news.
Mr. Shen Yuhua with Science News also contributed to this article.
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