Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly - The Rotterdam Study
Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly - The Rotterdam Study
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DOI：
10.1161/01.cir.0000018650.58984.75
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发表时间：
2002-06-18
期刊：
影响因子：
37.8
通讯作者：
Breteler, MMB
中科院分区：
文献类型：
--
作者：
Hollander, M;Bots, ML;Breteler, MMB
背景：很少有研究量化无症状患者的颈动脉斑块与中风之间的关系，并且关于斑块位置的重要性或与脑梗死亚型的关联的数据也有限。我们在一项基于人群的研究中调查了在不同位置测量的颈动脉斑块与中风和脑梗塞亚型风险之间的关系。 方法和结果 - 该研究基于鹿特丹研究，纳入了 4217 名年龄在 55 岁或以上、无神经系统症状的受试者。在基线时评估颈动脉 6 个位置是否存在颈动脉斑块。严重程度根据受影响站点的数量进行分类。平均随访 5.2 年后，共发生 160 例中风。使用 Cox 比例风险回归分析数据。无论斑块位于何处，斑块都会使中风和脑梗塞的风险增加约 1.5 倍。严重颈动脉斑块会增加前循环非腔隙性梗死的风险（RR 3.2 [95% CI，1.1 - 9.7]），但不会增加后循环非腔隙性梗死的风险（RR 0.6 [95% CI，0.1 - 4.9]）。在患有严重斑块的受试者中，发现腔隙性梗塞的风险增加了 10 倍以上（RR 10.8 [95% CI，1.7 至 69.7]）。同侧和对侧梗塞之间的风险估计没有明显差异。结论-颈动脉斑块会增加中风和脑梗塞的风险，无论其位置如何。斑块会增加前循环梗塞的风险，但不会增加后循环梗塞的风险。无神经症状受试者的颈动脉斑块很可能既是全身动脉粥样硬化的标志物，也是血栓栓塞的来源。
Background-Few studies have quantified the relation between carotid plaques and stroke in asymptomatic patients, and limited data exist on the importance of location of plaques or the association with subtypes of cerebral infarction. We investigated the relationship between carotid plaques, measured at different locations, and risk of stroke and subtypes of cerebral infarction in a population-based study.Methods and Results-The study was based on the Rotterdam Study and included 4217 neurologically asymptomatic subjects aged 55 years or older. Presence of carotid plaques at 6 locations in the carotid arteries was assessed at baseline. Severity was categorized according to the number of affected sites. After a mean follow-up of 5.2 years, 160 strokes had occurred. Data were analyzed using Cox proportional hazards regression. Plaques increased the risk of stroke and cerebral infarction approximate to1.5-fold, irrespective of plaque location. Severe carotid plaques increased the risk of nonlacunar infarction in anterior (RR 3.2 [95% CI, 1.1 to 9.7]) but not in posterior circulation (RR 0.6 [95% CI, 0.1 to 4.9]). A >10-fold increased risk of lacunar infarction was found in subjects with severe plaques (RR 10.8 [95% CI, 1.7 to 69.7]). No clear difference in risk estimates was seen between ipsilateral and contralateral infarction.Conclusions-Carotid plaques increase the risk of stroke and cerebral infarction, irrespective of their location. Plaques increase the risk of infarctions in the anterior but not in the posterior circulation. It is likely that carotid plaques in neurologically asymptomatic subjects are both markers of generalized atherosclerosis and sources of thromboemboli.