Prospective study of anxiety and incident stroke.
Prospective study of anxiety and incident stroke.
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前瞻性研究焦虑和事件中风。
DOI：
10.1161/strokeaha.113.003741
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发表时间：
2014-02
期刊：
影响因子：
8.3
通讯作者：
Thurston RC
中科院分区：
文献类型：
--
作者：
Lambiase MJ;Kubzansky LD;Thurston RC
较高程度的焦虑与冠心病风险增加有关。然而，很少有研究调查焦虑是否与中风风险相关。本研究的目的是在一项针对美国人口的全国代表性纵向研究中探讨焦虑症状与中风事件之间的关联。第一次全国健康与营养检查调查的参与者 (n=6019) 接受基线评估并随访 16.29±4.75 年。使用多变量 Cox 比例风险回归模型来估计与焦虑症状增加 1 个 SD 相关的中风事件的风险比和 95% 置信区间。模型针对标准心血管危险因素和抑郁症进行了调整。从医院/疗养院出院报告和死亡证明中总共发现了 419 例中风病例。在调整标准生物和行为心血管危险因素后，基线报告更多焦虑症状与中风风险增加相关（风险比，1.14；95%置信区间，1.03-1.25）。当另外控制抑郁症时，结果仍然存在。考虑到潜在混杂因素与途径变量的作用的探索性分析表明，行为因素可能是将焦虑与中风风险联系起来的关键途径。较高的焦虑症状水平与卒中风险增加存在前瞻性相关，独立于其他危险因素，包括抑郁症。焦虑是一种可以改变的体验，在普通人群中非常普遍。其评估和治疗可能有助于制定更有效的预防和干预策略，以改善整体心血管健康。
Higher levels of anxiety are associated with increased risk for coronary heart disease. However, few studies have investigated whether anxiety is associated with stroke risk. The purpose of this study was to examine the association between anxiety symptoms and incident stroke in a nationally representative longitudinal study of the US population. Participants (n=6019) in the First National Health and Nutrition Examination Survey were assessed at baseline and followed for 16.29±4.75 years. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals of incident stroke associated with a 1 SD increase in anxiety symptoms. Models were adjusted for standard cardiovascular risk factors and additionally for depression. A total of 419 incident stroke cases were identified from hospital/nursing home discharge reports and death certificates. Reporting more anxiety symptoms at baseline was associated with increased risk of incident stroke after adjusting for standard biological and behavioral cardiovascular risk factors (hazard ratio, 1.14; 95% confidence interval, 1.03–1.25). Findings persisted when additionally controlling for depression. Exploratory analyses considering the role of potential confounding versus pathway variables suggested that behavioral factors may be a key pathway linking anxiety to stroke risk. Higher anxiety symptom levels were associated prospectively with increased risk for incident stroke independent of other risk factors, including depression. Anxiety is a modifiable experience that is highly prevalent among the general population. Its assessment and treatment may contribute to developing more effective preventive and intervention strategies for improving overall cardiovascular health.