Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer.
Incidental Statin Use and the Risk of Stroke or Transient Ischemic Attack after Radiotherapy for Head and Neck Cancer.
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DOI：
10.5853/jos.2017.01802
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发表时间：
2018-01
影响因子：
8.2
通讯作者：
Neilan TG
中科院分区：
文献类型：
--
作者：
Addison D;Lawler PR;Emami H;Janjua SA;Staziaki PV;Hallett TR;Hennessy O;Lee H;Szilveszter B;Lu M;Mousavi N;Nayor MG;Delling FN;Romero JM;Wirth LJ;Chan AW;Hoffmann U;Neilan TG
需要采取干预措施降低头颈癌（HNCA）放疗（RT）后脑血管事件（CVE；卒中和短暂性脑缺血发作[TIA]）的风险。在广泛的人群中，他汀类药物可以降低cve；然而，他汀类药物是否能降低HNCA RT后的cve尚不清楚。因此，我们的目的是测试在RT时偶然使用他汀类药物是否与HNCA RT后较低的cve发生率相关。从一个机构数据库中，我们确定了2002年至2012年期间所有连续接受颈部RT治疗的HNCA患者。数据收集和项目评审由盲法小组进行。主要结局是缺血性卒中和TIA的综合结果。次要终点为缺血性卒中。他汀类药物的使用与事件之间的关系是在调整了传统和rt特异性风险因素后，使用Cox比例风险模型确定的。最终队列包括1011例患者（59±13岁，30%女性，44%高血压），其中288例（28%）服用他汀类药物。在中位3.4年的随访期间（四分位数范围0.1 - 14），有102例CVEs(89例缺血性卒中和13例tia)，其中他汀类药物服用者17例，非他汀类药物服用者85例。在包含已知CVE预测因子的多变量模型中，他汀类药物与卒中合并TIA（风险比[HR]， 0.4； 95%可信区间[CI]， 0.2至0.8；P=0.01）和单独缺血性卒中（HR, 0.4; 95% CI， 0.2至0.8；P=0.01）的减少相关。在HNCA RT时偶然使用他汀类药物与卒中或TIA的风险较低相关。
Interventions to reduce the risk for cerebrovascular events (CVE; stroke and transient ischemic attack [TIA]) after radiotherapy (RT) for head and neck cancer (HNCA) are needed. Among broad populations, statins reduce CVEs; however, whether statins reduce CVEs after RT for HNCA is unclear. Therefore, we aimed to test whether incidental statin use at the time of RT is associated with a lower rate of CVEs after RT for HNCA. From an institutional database we identified all consecutive subjects treated with neck RT from 2002 to 2012 for HNCA. Data collection and event adjudication was performed by blinded teams. The primary outcome was a composite of ischemic stroke and TIA. The secondary outcome was ischemic stroke. The association between statin use and events was determined using Cox proportional hazard models after adjustment for traditional and RT-specific risk factors. The final cohort consisted of 1,011 patients (59±13 years, 30% female, 44% hypertension) with 288 (28%) on statins. Over a median follow-up of 3.4 years (interquartile range, 0.1 to 14) there were 102 CVEs (89 ischemic strokes and 13 TIAs) with 17 in statin users versus 85 in nonstatins users. In a multivariable model containing known predictors of CVE, statins were associated with a reduction in the combination of stroke and TIA (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.2 to 0.8; P=0.01) and ischemic stroke alone (HR, 0.4; 95% CI, 0.2 to 0.8; P=0.01). Incidental statin use at the time of RT for HNCA is associated with a lower risk of stroke or TIA.
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影响因子：
8.3
作者：
Meschia JF;Bushnell C;Boden-Albala B;Braun LT;Bravata DM;Chaturvedi S;Creager MA;Eckel RH;Elkind MS;Fornage M;Goldstein LB;Greenberg SM;Horvath SE;Iadecola C;Jauch EC;Moore WS;Wilson JA;American Heart Association Stroke Council;Council on Cardiovascular and Stroke Nursing;Council on Clinical Cardiology;Council on Functional Genomics and Translational Biology;Council on Hypertension
通讯作者：
Council on Hypertension
影响因子：
37.8
作者：
Morawietz, Henning;Erbs, Sandra;Hambrecht, Rainer
通讯作者：
Hambrecht, Rainer
影响因子：
158.5
作者：
Bernier, J;Domenge, C;van Glabbeke, M
通讯作者：
van Glabbeke, M
影响因子：
45.3
作者：
Dorresteijn, LDA;Kappelle, AC;Bartelink, H
通讯作者：
Bartelink, H
影响因子：
158.5
作者：
Bonner, JA;Harari, PM;Ang, KK
通讯作者：
Ang, KK