Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke - The Rotterdam study
Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke - The Rotterdam study
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DOI：
10.1161/strokeaha.107.489807
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发表时间：
2007-12-01
期刊：
影响因子：
8.3
通讯作者：
Breteler, Monique M. B.
中科院分区：
文献类型：
--
作者：
Bos, Michiel J.;Koudstaal, Peter J.;Breteler, Monique M. B.
背景和目的：早期慢性肾脏病患者（肾小球滤过率（GFR）降低）发生心血管疾病的风险增加。目前尚不清楚GFR降低是否是中风的危险因素。我们评估了GFR和中风之间的关联在一个前瞻性的人口为基础的队列study.Methods -这项研究是基于4937名参与者的鹿特丹研究谁在基线（1990年至1993年）年龄在55岁或以上，无中风，并有血清肌酐评估。采用Cockcroft-Gault方程估计GFR。对脑血管疾病事件的随访完成至2005年1月1日。数据进行了分析与考克斯比例风险模型调整相关的混杂因素和结果表示为风险比与95%CIs.Results-在平均随访10.2年，586中风（338缺血性，44出血性，和204未指明的中风）发生。我们发现GFR与总体卒中风险或缺血性卒中风险之间无相关性。相反，随着GFR降低，出血性卒中的风险显著增加; GFR最低与最高四分位数的出血性卒中的年龄和性别校正风险比为4.10（95% CI，1.25 - 13.42），并且存在明确且高度显著的剂量-效应关系。其他血管危险因素的调整仅轻微减弱了这种关联。结论：GFR降低是出血性卒中的一个强危险因素，但不是缺血性卒中。
Background and Purpose - Persons with early stages of chronic kidney disease, defined by a decreased glomerular filtration rate (GFR), have an increased risk of cardiovascular disease. It is unclear whether decreased GFR is a risk factor for stroke. We assessed the association between GFR and stroke in a prospective population-based cohort study.Methods - The study was based on 4937 participants of the Rotterdam Study who at baseline (1990 to 1993) were aged 55 years or over, free from stroke, and had serum creatinine assessment. GFR was estimated with the Cockcroft-Gault equation. Follow-up for incident cerebrovascular disease was complete until January 1, 2005. Data were analyzed with Cox proportional hazards models with adjustment for relevant confounders and results were expressed as hazard ratios with 95% CIs.Results - During an average follow-up of 10.2 years, 586 strokes (338 ischemic, 44 hemorrhagic, and 204 unspecified strokes) occurred. We found no association between GFR and risk of overall stroke or risk of ischemic stroke. In contrast, with decreasing GFR, the risk of hemorrhagic stroke strongly increased; the age- and sex-adjusted hazard ratio for hemorrhagic stroke was 4.10 (95% CI, 1.25 to 13.42) for lowest versus highest quartile of GFR, and there was a clear and highly significant dose - effect relationship. Adjustment for other vascular risk factors only slightly attenuated this association.Conclusions - Decreased GFR is a strong risk factor for hemorrhagic, but not ischemic stroke.