Interaction of diabetes and smoking on stroke: a population-based cross-sectional survey in China
ObjectivesDiabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults.DesignCross-sectional study.SettingCommunity-based investigation in Xuzhou, Chi...
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| Published in | BMJ open Vol. 8; no. 4; p. e017706 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
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England
BMJ Publishing Group LTD
01.04.2018
BMJ Publishing Group |
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| Abstract | ObjectivesDiabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults.DesignCross-sectional study.SettingCommunity-based investigation in Xuzhou, China.ParticipantsA total of 39 887 Chinese adults who fulfilled the inclusion criteria were included.MethodsParticipants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model.ResultsAfter adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively.ConclusionsThe results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults. |
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| AbstractList | Diabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults.OBJECTIVESDiabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults.Cross-sectional study.DESIGNCross-sectional study.Community-based investigation in Xuzhou, China.SETTINGCommunity-based investigation in Xuzhou, China.A total of 39 887 Chinese adults who fulfilled the inclusion criteria were included.PARTICIPANTSA total of 39 887 Chinese adults who fulfilled the inclusion criteria were included.Participants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model.METHODSParticipants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model.After adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively.RESULTSAfter adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively.The results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults.CONCLUSIONSThe results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults. ObjectivesDiabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults.DesignCross-sectional study.SettingCommunity-based investigation in Xuzhou, China.ParticipantsA total of 39 887 Chinese adults who fulfilled the inclusion criteria were included.MethodsParticipants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model.ResultsAfter adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively.ConclusionsThe results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults. Diabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such interaction and its influence on stroke in Chinese adults. Cross-sectional study. Community-based investigation in Xuzhou, China. A total of 39 887 Chinese adults who fulfilled the inclusion criteria were included. Participants were selected using a multistage stratified cluster method, and completed self-reported questionnaires on stroke and smoking. Type 2 diabetes mellitus (DM2) was assessed by fasting blood glucose or use of antidiabetic medication. Interaction, relative excess risk owing to interaction (RERI), attributable proportion (AP) and synergy index (S) were evaluated using a logistic regression model. After adjustment for age, sex, marital status, educational level, occupation, physical activity, body mass index, hypertension, family history of stroke, alcohol use and blood lipids, the relationships between DM2 and stroke, and between smoking and stroke, were still significant: ORs were 2.75 (95% CI 2.03 to 3.73) and 1.70 (95% CI 1.38 to 2.10), respectively. In subjects with DM2 who smoked, the RERI, AP and S values (and 95% CIs) were 1.80 (1.24 to 3.83), 0.52 (0.37 to 0.73) and 1.50 (1.18 to 1.84), respectively. The results suggest there are additive interactions between DM2 and smoking and that these affect stroke in Chinese adults. |
| Author | Zhang, Pan Lou, Heqing Li, Ting Zhao, Chunyan Zhang, Xunbao Dong, Zongmei Lou, Peian Shao, Xiaoping |
| AuthorAffiliation | 2 Department of Non-communicable Disease Control , Xuzhou Center for Disease Control and Prevention , Xuzhou , China 1 The School of Public Health , Xuzhou Medical University , Xuzhou , China |
| AuthorAffiliation_xml | – name: 2 Department of Non-communicable Disease Control , Xuzhou Center for Disease Control and Prevention , Xuzhou , China – name: 1 The School of Public Health , Xuzhou Medical University , Xuzhou , China |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29622573$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1253/circj.CJ-13-0786 10.1161/01.STR.29.8.1656 10.1016/j.jstrokecerebrovasdis.2016.12.002 10.1016/j.jstrokecerebrovasdis.2016.02.031 10.1007/s10654-011-9554-9 10.1056/NEJMoa1501451 10.1016/S0140-6736(17)32152-9 10.1371/journal.pone.0163171 10.1177/1479164113479618 10.1093/ije/dym157 10.1097/00001648-199209000-00012 10.1016/S1474-4422(16)30073-4 10.1007/s11011-014-9538-z 10.4172/2157-7609.1000153 10.1161/STROKEAHA.113.002342 10.1055/s-0034-1396413 10.1007/s00125-004-1587-0 10.1007/s00125-013-3058-y 10.1016/S0140-6736(13)61097-1 10.3390/ijerph13020158 10.2337/diacare.22.7.1077 10.1001/jamacardio.2016.1702 10.3967/bes2016.084 10.1371/journal.pone.0066176 10.3164/jcbn.15-3 10.1111/ijs.12508 10.1586/erc.10.56 10.1016/S0033-0620(03)00087-2 10.1371/journal.pone.0153178 10.1111/dme.13057 10.1161/01.STR.20.11.1581 10.1002/brb3.461 10.1186/s12883-015-0505-z 10.1161/01.STR.0000177475.30281.7f 10.1016/S0140-6736(14)60040-4 10.1161/01.CIR.0000066691.52789.BE 10.1001/jama.2013.168118 10.1161/STR.0b013e318296aeca 10.1186/s12974-016-0774-5 10.1016/S0140-6736(10)60834-3 10.1161/CIRCULATIONAHA.116.025250 10.1038/hr.2015.90 10.1161/STROKEAHA.115.010203 10.1097/MD.0000000000002282 10.1111/j.2040-1124.2010.00018.x 10.1212/WNL.0b013e31829bfde3 |
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| References | Ottum, Mistry 2015; 57 Robson, Lacey, Luzio 2016; 33 Papademetriou, Narayan, Rubins 1998; 136 Iso, Imano, Kitamura 2004; 47 2017; 390 Pan, Wang, Li 2016; 11 Knol, VanderWeele, Groenwold 2011; 26 Feigin, Roth, Naghavi 2016; 15 Benowitz 2003; 46 Wang, Wen, Li 2017; 26 Wang, Jiang, Sun 2017; 135 Hosmer, Lemeshow 1992; 3 Zhong, Zhong, Xu 2015; 38 Wolf, D’Agostino, Kannel 1988; 259 Prasad, Dhar, Caspar-Bell 2015; 24 Du, Li, Bennett 2016; 374 Yang, Wang, Zeng 2013; 381 Peters, Huxley, Woodward 2014; 383 Shukla, Shakya, Perez-Pinzon 2017; 14 Sacco, Kasner, Broderick 2013; 44 Zhang, Yan, Shi 2013; 4 Guo, Wang, Tao 2016; 11 Peters, Huxley, Woodward 2013; 44 Zhou 2002; 15 Aronson, Rayfield 2002; 1 2012; 20 Hata, Kiyohara 2013; 77 Biswas, Mudi, Mollah 2013; 10 1919; 2011 Soulimane, Simon, Herman 2014; 57 Kitada, Zhang, Mima 2010; 1 Mi, Sun, Du 2016; 6 Folsom, Rasmussen, Chambless 1999; 22 Zhang, Jiao, Zhou 2007; 28 Xu, Wang, He 2013; 310 Wannamethee, Shaper, Whincup 1995; 274 Iida, Iida, Dohi 1998; 29 Qureshi, Suri, Kirmani 2005; 36 Rehni, Nautiyal, Perez-Pinzon 2015; 30 Muñoz-Rivas, Méndez-Bailón, Hernández-Barrera 2016; 25 Chang, Gajasinghe, Arambepola 2015; 46 Kemeny, Figueroa, Clyne 2013; 8 Tsai, Thomas, Sudlow 2013; 81 Shah, Cole 2010; 8 Ding, Xu, Wang 2016; 29 Knol, van der Tweel, Grobbee 2007; 36 Chang, Kim, Kim 2016; 13 O’Donnell, Xavier, Liu 2010; 376 Chen, Wu, Zhou 2015; 8 Shi, Hart, Sherman 1989; 20 Tsai, Anderson, Thomas 2015; 10 Liao, Shih, Yeh 2015; 94 Barua, Ambrose, Srivastava 2003; 107 Wu, Wang, Wang 2015; 15 Bragg, Li, Bennett 2016; 1 |
| References_xml | – volume: 15 start-page: 83 year: 2002 article-title: Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults publication-title: Biomed Environ Sci – volume: 77 start-page: 1923 year: 2013 article-title: Epidemiology of stroke and coronary artery disease in Asia publication-title: Circ J doi: 10.1253/circj.CJ-13-0786 – volume: 29 start-page: 1656 year: 1998 article-title: Mechanisms underlying cerebrovascular effects of cigarette smoking in rats in vivo publication-title: Stroke doi: 10.1161/01.STR.29.8.1656 – volume: 26 start-page: 509 year: 2017 article-title: Risk factors for stroke in the Chinese population: a systematic review and meta-analysis publication-title: J Stroke Cerebrovasc Dis doi: 10.1016/j.jstrokecerebrovasdis.2016.12.002 – volume: 20 start-page: 1 year: 2012 article-title: 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack publication-title: Chinese Journal of Diabetes – volume: 2011 start-page: 701 year: 1919 article-title: China hypertension prevention guidelines revision committee. Guidelines for prevention and treatment of hypertension in China[2010 Edition] publication-title: Chinese Journal of hypertension – volume: 25 start-page: 1431 year: 2016 article-title: Type 2 diabetes and hemorrhagic stroke: a population-based study in Spain from 2003 to 2012 publication-title: J Stroke Cerebrovasc Dis doi: 10.1016/j.jstrokecerebrovasdis.2016.02.031 – volume: 26 start-page: 433 year: 2011 article-title: Estimating measures of interaction on an additive scale for preventive exposures publication-title: Eur J Epidemiol doi: 10.1007/s10654-011-9554-9 – volume: 374 start-page: 1332 year: 2016 article-title: Fresh fruit consumption and major cardiovascular disease in China publication-title: N Engl J Med doi: 10.1056/NEJMoa1501451 – volume: 390 start-page: 1151 year: 2017 article-title: Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016 publication-title: Lancet doi: 10.1016/S0140-6736(17)32152-9 – volume: 11 year: 2016 article-title: Determinants and time trends for ischaemic and haemorrhagic stroke in a large Chinese population publication-title: PLoS One doi: 10.1371/journal.pone.0163171 – volume: 28 start-page: 625 year: 2007 article-title: [Studies on prevalence and control of several common chronic diseases among Beijing adults in 2005] publication-title: Zhonghua Liu Xing Bing Xue Za Zhi – volume: 10 start-page: 380 year: 2013 article-title: Serum soluble receptor for advanced glycation end products (sRAGE) is independently associated with cigarette smoking in non-diabetic healthy subjects publication-title: Diab Vasc Dis Res doi: 10.1177/1479164113479618 – volume: 36 start-page: 1111 year: 2007 article-title: Estimating interaction on an additive scale between continuous determinants in a logistic regression model publication-title: Int J Epidemiol doi: 10.1093/ije/dym157 – volume: 3 start-page: 452 year: 1992 article-title: Confidence interval estimation of interaction publication-title: Epidemiology doi: 10.1097/00001648-199209000-00012 – volume: 15 start-page: 913 year: 2016 article-title: Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the global burden of disease Study 2013 publication-title: Lancet Neurol doi: 10.1016/S1474-4422(16)30073-4 – volume: 30 start-page: 437 year: 2015 article-title: Hyperglycemia / hypoglycemia-induced mitochondrial dysfunction and cerebral ischemic damage in diabetics publication-title: Metab Brain Dis doi: 10.1007/s11011-014-9538-z – volume: 259 start-page: 1025 year: 1988 article-title: Cigarette smoking as a risk factor for stroke. The Framingham Study publication-title: JAMA – volume: 4 start-page: 153 year: 2013 article-title: Hyperglycemia as a risk factor of ischemic stroke publication-title: J Drug Metab Toxicol doi: 10.4172/2157-7609.1000153 – volume: 44 start-page: 2821 year: 2013 article-title: Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes publication-title: Stroke doi: 10.1161/STROKEAHA.113.002342 – volume: 24 start-page: 75 year: 2015 article-title: Role of advanced glycation end products and its receptors in the pathogenesis of cigarette smoke-induced cardiovascular disease publication-title: Int J Angiol doi: 10.1055/s-0034-1396413 – volume: 47 start-page: 2137 year: 2004 article-title: Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women publication-title: Diabetologia doi: 10.1007/s00125-004-1587-0 – volume: 57 start-page: 30 year: 2014 article-title: HbA1c, fasting and 2 h plasma glucose in current, ex- and never-smokers: a meta-analysis publication-title: Diabetologia doi: 10.1007/s00125-013-3058-y – volume: 381 start-page: 1987 year: 2013 article-title: Rapid health transition in China, 1990-2010: findings from the global burden of disease study 2010 publication-title: Lancet doi: 10.1016/S0140-6736(13)61097-1 – volume: 13 start-page: 158 year: 2016 article-title: Association between smoking and physician-diagnosed stroke and myocardial infarction in male adults in Korea publication-title: Int J Environ Res Public Health doi: 10.3390/ijerph13020158 – volume: 136 start-page: 734 issue: Pt 1 year: 1998 article-title: Influence of risk factors on peripheral and cerebrovascular disease in men with coronary artery disease, low high-density lipoprotein cholesterol levels, and desirable low-density lipoprotein cholesterol levels. HIT Investigators. Department of Veterans Affairs HDL Intervention Trial publication-title: Am Heart J – volume: 22 start-page: 1077 year: 1999 article-title: Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators publication-title: Diabetes Care doi: 10.2337/diacare.22.7.1077 – volume: 1 start-page: 813 year: 2016 article-title: Association of random plasma glucose levels with the risk for cardiovascular disease among Chinese adults without known diabetes publication-title: JAMA Cardiol doi: 10.1001/jamacardio.2016.1702 – volume: 29 start-page: 619 year: 2016 article-title: Smoking and its relation to metabolic status among Chinese adults: analysis of a nationwide survey publication-title: Biomed Environ Sci doi: 10.3967/bes2016.084 – volume: 8 year: 2013 article-title: Hypo- and hyperglycemia impair endothelial cell actin alignment and nitric oxide synthase activation in response to shear stress publication-title: PLoS One doi: 10.1371/journal.pone.0066176 – volume: 57 start-page: 1 year: 2015 article-title: Advanced glycation end-products: modifiable environmental factors profoundly mediate insulin resistance publication-title: J Clin Biochem Nutr doi: 10.3164/jcbn.15-3 – volume: 10 start-page: 485 year: 2015 article-title: Risk factors for ischemic stroke and its subtypes in Chinese vs. Caucasians: systematic review and meta-analysis publication-title: Int J Stroke doi: 10.1111/ijs.12508 – volume: 8 start-page: 917 year: 2010 article-title: Smoking and stroke: the more you smoke the more you stroke publication-title: Expert Rev Cardiovasc Ther doi: 10.1586/erc.10.56 – volume: 46 start-page: 91 year: 2003 article-title: Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment publication-title: Prog Cardiovasc Dis doi: 10.1016/S0033-0620(03)00087-2 – volume: 11 year: 2016 article-title: Association of diabetes and prognosis of minor stroke and its subtypes: a prospective observational study publication-title: PLoS One doi: 10.1371/journal.pone.0153178 – volume: 33 start-page: 459 year: 2016 article-title: HbA1c measurement and relationship to incident stroke publication-title: Diabet Med doi: 10.1111/dme.13057 – volume: 20 start-page: 1581 year: 1989 article-title: Stroke in the People’s Republic of China publication-title: Stroke doi: 10.1161/01.STR.20.11.1581 – volume: 6 start-page: e00461 year: 2016 article-title: Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China publication-title: Brain Behav doi: 10.1002/brb3.461 – volume: 15 start-page: 253 year: 2015 article-title: Factors for short-term outcomes in patients with a minor stroke: results from China national stroke registry publication-title: BMC Neurol doi: 10.1186/s12883-015-0505-z – volume: 36 start-page: e74 year: 2005 article-title: Cigarette smoking among spouses: another risk factor for stroke in women publication-title: Stroke doi: 10.1161/01.STR.0000177475.30281.7f – volume: 8 start-page: 4446 year: 2015 article-title: Relationship between increase of serum homocysteine caused by smoking and oxidative damage in elderly patients with cardiovascular disease publication-title: Int J Clin Exp Med – volume: 383 start-page: 1973 year: 2014 article-title: Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes publication-title: Lancet doi: 10.1016/S0140-6736(14)60040-4 – volume: 107 start-page: 2342 year: 2003 article-title: Reactive oxygen species are involved in smoking-induced dysfunction of nitric oxide biosynthesis and upregulation of endothelial nitric oxide synthase: an in vitro demonstration in human coronary artery endothelial cells publication-title: Circulation doi: 10.1161/01.CIR.0000066691.52789.BE – volume: 310 start-page: 948 year: 2013 article-title: Prevalence and control of diabetes in Chinese adults publication-title: JAMA doi: 10.1001/jama.2013.168118 – volume: 44 start-page: 2064 year: 2013 article-title: An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association publication-title: Stroke doi: 10.1161/STR.0b013e318296aeca – volume: 14 start-page: 21 year: 2017 article-title: Cerebral ischemic damage in diabetes: an inflammatory perspective publication-title: J Neuroinflammation doi: 10.1186/s12974-016-0774-5 – volume: 1 start-page: 1:1 year: 2002 article-title: How hyperglycemia promotes atherosclerosis: molecular mechanisms publication-title: Cardiovasc Diabetol – volume: 376 start-page: 112 year: 2010 article-title: Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study publication-title: Lancet doi: 10.1016/S0140-6736(10)60834-3 – volume: 135 start-page: 759 year: 2017 article-title: Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults publication-title: Circulation doi: 10.1161/CIRCULATIONAHA.116.025250 – volume: 38 start-page: 883 year: 2015 article-title: Combined effects of hypertension and heart rate on the risk of stroke and coronary heart disease: a population-based prospective cohort study among Inner Mongolians in China publication-title: Hypertens Res doi: 10.1038/hr.2015.90 – volume: 46 start-page: 2965 year: 2015 article-title: Prevalence of stroke and its risk factors in Urban Sri Lanka: population-based study publication-title: Stroke doi: 10.1161/STROKEAHA.115.010203 – volume: 94 year: 2015 article-title: Impact of diabetes on stroke risk and outcomes: two nationwide retrospective cohort studies publication-title: Medicine doi: 10.1097/MD.0000000000002282 – volume: 1 start-page: 77 year: 2010 article-title: Molecular mechanisms of diabetic vascular complications publication-title: J Diabetes Investig doi: 10.1111/j.2040-1124.2010.00018.x – volume: 274 start-page: 155 year: 1995 article-title: Smoking cessation and the risk of stroke in middle-aged men publication-title: JAMA – volume: 81 start-page: 264 year: 2013 article-title: Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review publication-title: Neurology doi: 10.1212/WNL.0b013e31829bfde3 |
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| Snippet | ObjectivesDiabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore... Diabetes and smoking are known independent risk factors for stroke; however, their interaction concerning stroke is less clear. We aimed to explore such... |
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| SubjectTerms | Alcohol Antidiabetics Blood pressure Cardiovascular disease Cigarettes Cross-sectional studies Diabetes Epidemiology Family medical history Fasting Health risk assessment Heart rate Hyperglycemia Hypertension Population Secondary schools Smoking Statistical analysis Stroke |
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| Title | Interaction of diabetes and smoking on stroke: a population-based cross-sectional survey in China |
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