Systematic review of risk factors for progressive ischemic stroke

OBJECTIVE: To determine the risk factors for progressive ischemic stroke, and to prevent onset and make a prognosis of disease, the present study systemically evaluated 19 cohort studies and 10 case-controlled studies of progressive ischemic stroke. SEARCH STRATEGY: A computer-based, online, literature search of PubMed (1966/2007), China Biological Medicine Database (CBM-disc, 1979/2007) and CNKI (www.cnki.net, 1979/2007) was performed to screen for related studies. DATA SELECTION: Cohort or case-controlled studies that focused on risk factors of progressive ischemic stroke were selected for review. Two reviewers independently extracted data and assessed study quality according to Cochrane Collaboration guidelines. Statistical analysis was performed using Rev Man software. MAIN OUTCOME MEASUREMENT: Risk factors for progressive ischemic stroke. RESULTS: Using the inclusion criteria, 29/781 studies published in English and Chinese were initially reviewed, including 19 cohort studies and 10 case-control studies. Despite variations in determination of progressive ischemic stroke and the intervals between 2 evaluations, all studies described the diagnostic criteria for progressive ischemic stroke. Logistic analysis was employed in 20 of the studies. Meta-analysis of primary data in the related studies determined that the following factors that significantly correlated with progressive ischemic stroke: fever [risk ratio (RR) = 2.26, 95% confidence interval (Cl): 1.20-4.26, P = 0.01; odds ratio (OR) = 2.85, 95% Cl: 1.64-4.98, P < 0.01)]; diabetes (RR = 1.38, 95% CI: 1.18-1.61, P < 0.01; OR = 2.48, 95% CI: 1.93-3.19, P < 0.01); coronary heart disease (RR = 1.22, 95% CI: 1.08-1.38, P < 0.01); neuroimaging transformation (RR = 1.55, 95% CI: 1.34-1.80, P < 0.01; OR = 2.29, 95% CI: 1.47-3.58, P < 0.01); and hyperglycemia (RR = 2.62, 95% CI: 1.86-3.68, P < 0.01; OR = 3.49, 95% CI: 1.92-6.35, P < 0.01). CONCLUSION: Fever, diabetes, coronary heart disease, neuroimaging transformation, and hyperglycemia are important risk factors for progressive ischemic stroke. Interventions for these risk factors could effectively prevent occurrence of progressive ischemic stroke.