Ischemic stroke subtypes and migraine with visual aura in the ARIC study
Ischemic stroke subtypes and migraine with visual aura in the ARIC study
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DOI：
10.1212/wnl.0000000000003428
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发表时间：
2016-12-13
期刊：
影响因子：
9.9
通讯作者：
Sen, Souvik
中科院分区：
文献类型：
--
作者：
Androulakis, X. Michelle;Kodumuri, Nishanth;Sen, Souvik
目的：调查偏头痛，缺血性中风，中风亚型之间的关联在社区动脉粥样硬化风险（ARIC）study.Methods：在这个正在进行的，前瞻性的，纵向的社区为基础的队列研究，参与者进行了采访，确定偏头痛的历史在1993-1995年，并遵循所有血管事件，包括中风。随后20年内的所有卒中事件均经裁定，并按标准定义分类为卒中亚型。调整中风危险因素后的考克斯比例风险模型被用于研究偏头痛和缺血性中风之间的关系，总体上，以及中风亚型（心源性栓塞，腔隙性或血栓性）。第3次临床访视时研究人群的平均年龄为59岁。与非头痛受试者相比，有视觉先兆的偏头痛与缺血性卒中之间存在显著相关性（风险比[HR] 1.7，95%置信区间[CI] 1.2-2.6，p = 0.008）。与非头痛受试者相比，无视觉先兆的偏头痛与缺血性卒中无显著相关性（HR 1.2，CI 1.0-1.8，p = 0.28）。在评估的3种缺血性卒中亚型中，有视觉先兆的偏头痛仅与心源性卒中显著相关（HR 3.7，95%CI 1.6-8.7，p = 0.003）。结论：在中年晚期有视觉先兆的偏头痛患者中，观察到心源性卒中的风险增加。在20年的时间里，有视觉先兆的偏头痛与中风风险增加有关，而无视觉先兆的偏头痛则与此无关。这些结果是针对老年偏头痛患者的。
Objective: To investigate the association among migraine, ischemic stroke, and stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study.Methods: In this ongoing, prospective, longitudinal community-based cohort study, participants were given an interview ascertaining migraine history in 1993-1995, and were followed for all vascular events, including stroke. All stroke events over the subsequent 20 years were adjudicated and classified into stroke subtypes by standard definitions. Cox proportional hazards models adjusted for stroke risk factors were used to study the relationship between migraine and ischemic stroke, overall, as well as stroke subtypes (cardioembolic, lacunar, or thrombotic).Results: We identified 1,622 migraineurs among 12,758 participants. Mean age of the study population at the 3rd clinical visit was 59 years. When compared to nonheadache participants, there was a significant association between migraine with visual aura and ischemic stroke (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.2-2.6, p = 0.008). Migraine without visual aura was not significantly associated with ischemic stroke (HR 1.2, CI 1.0-1.8, p = 0.28) when compared to nonheadache participants. Among the 3 subtypes of ischemic stroke evaluated, migraine with visual aura was significantly associated only with cardioembolic stroke (HR 3.7, 95% CI 1.6-8.7, p = 0.003).Conclusion: In participants with migraine with visual aura in late middle age, increased risk of cardioembolic stroke was observed. Migraine with visual aura was linked to increased stroke risk, while migraine without visual aura was not, over the period of 20 years. These results are specific to older migraineurs.