Review Volume 13, Issue 11 pp 15659—15673

Exploring stroke risk and prevention in China: insights from an outlier

Xinrou Lin1, *, , Hongxuan Wang1, *, , Xiaoming Rong1, *, , Ruxun Huang2, , Ying Peng1,3, ,

  • 1 Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
  • 2 Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
  • 3 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
* Equal contribution

Received: November 25, 2020       Accepted: May 11, 2021       Published: June 4, 2021
How to Cite

Copyright: © 2021 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


In contrast to the declining trend in most regions worldwide, the incidence of stroke is increasing in China and is leading to an alarming burden for the national healthcare system. In this review, we have generated new insights from this outlier, and we aim to provide new information that will help decrease the global stroke burden, especially in China and other regions sharing similar problems with China. First of all, several unsolved aspects fundamentally accounting for this discrepancy were promising, including the serious situation of hypertension management, underdiagnosis of atrial fibrillation and underuse of anticoagulants, and unhealthy lifestyles (e.g., heavy smoking). In addition, efforts for further alleviating the incidence of stroke were recommended in certain fields, including targeted antiplatelet regimes and protections from cold wave-related stroke. Furthermore, advanced knowledge about cancer-related strokes, recurrent strokes and the status preceding stroke onset that we called stroke-prone status herein, is required to properly mitigate patient stroke risk, and to provide improved outcomes for patients after a stroke has occurred.


ACE: artificial cold exposure; AF: atrial fibrillation; DALYs: disability-adjusted life-years; ICH: intracerebral hemorrhage; INR: international normalized ratio; IS: ischemic stroke; NOAC: new oral anticoagulants; NVAF: non-valvular atrial fibrillation; OR: odds ratio; PAR: population-attributable risk; RCT: randomized controlled trial; SBP: systolic blood pressure; TIA: transient ischemic attack.