Assessment of the Role of Carotid Atherosclerosis in the Association Between Major Cardiovascular Risk Factors and Ischemic Stroke Subtypes
Assessment of the Role of Carotid Atherosclerosis in the Association Between Major Cardiovascular Risk Factors and Ischemic Stroke Subtypes
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DOI：
10.1001/jamanetworkopen.2019.4873
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Qiu, Zhe
中科院分区：
文献类型：
--
作者：
Parish, Sarah;Arnold, Matthew;Qiu, Zhe
目的为探讨颈动脉粥样硬化在主要心血管危险因素与缺血性卒中亚型之间的关系，探讨颈动脉粥样硬化在缺血性卒中亚型与主要心血管危险因素之间关系中的作用。设计、背景与对象中国嘉道理生物库队列前瞻性研究于2004年6月至2008年7月在中国市区和农村各5个普通人群中进行。纳入随机抽样的23973名登记时没有心血管疾病病史的参与者，他们在2013年9月至2014年6月的重新调查中进行了颈动脉超声测量。数据分析从2016年7月1日到2019年4月10日进行。主要心血管危险因素(即血压、血脂水平、吸烟和糖尿病)。主要结果和测量颈动脉超声测量斑块负荷(来自重新测量时颈动脉斑块的数量和最大尺寸)和随访期间首次缺血性中风(n=952)，分型(数据发布，2018年8月)为腔隙(n=263)、可能的大动脉(n=193)、可能的心血栓(n=66)或未确诊(n=430)。心血管危险因素、颈动脉斑块负荷和缺血性中风亚型之间的关系被调整为年龄、性别和地理区域。结果23973名参与者的平均年龄(SD)为50.6(10.0)岁，其中14833名(61.9%)为女性。与斑块负荷(OR/SD，1.34；95%CI，1.26~1.44)相比，颈动脉收缩压与缺血性卒中的相关性(优势比[OR]/SD，1.51；95%CI，1.42~1.61)强于斑块负荷(OR/SD，1.34；95%CI，1.26~1.44)，经斑块负荷调整后，其与各亚型缺血性卒中的相关性略有减弱。调整BP后，斑块负荷与可能的大动脉卒中(OR，1.43；95%CI，1.24-1.63)比腔隙性卒中(OR，1.25；95%CI，1.10-1.43)有更强的相关性，但与可能的心栓性卒中(OR，1.06；结论血压是所有缺血性卒中亚型的重要危险因素，颈动脉粥样硬化仅是大动脉和腔隙性卒中的重要危险因素，提示针对动脉粥样硬化的药物治疗可以不同程度地降低卒中亚型的风险。
IMPORTANCE A better understanding of the role of atherosclerosis in the development of ischemic stroke subtypes could help to improve strategies for prevention of stroke worldwide.OBJECTIVE To assess the role of carotid atherosclerosis in the association between major cardiovascular risk factors and ischemic stroke subtypes.DESIGN, SETTING, AND PARTICIPANTS The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey obtained between June 2004 and July 2008. A random sample of 23 973 participants with no history of cardiovascular disease at enrollment who had carotid artery ultrasonographic measurements recorded at a resurvey from September 2013 to June 2014 were included. Data analysis was performed from July 1, 2016, to April 10, 2019.EXPOSURES Major cardiovascular risk factors (ie, blood pressure [BP], blood lipid levels, smoking, and diabetes).MAIN OUTCOMES AND MEASURES Carotid ultrasonographic measures of plaque burden (derived from number and maximum size of carotid artery plaques at resurvey) and first ischemic stroke during follow-up (n = 952), with subtyping (data release, August 2018) as lacunar (n = 263), probable large artery (n = 193), probable cardioembolic (n = 66), or unconfirmed (n = 430). Associations between cardiovascular risk factors, carotid plaque burden, and ischemic stroke subtypes were adjusted for age, sex, and geographic area.RESULTS The 23 973 participants in the study had a mean (SD) age of 50.6 (10.0) years, and 14 833 (61.9%) were women. Systolic BP had a stronger association (odds ratio [OR] per SD, 1.51; 95% CI, 1.42-1.61) than plaque burden (OR per SD, 1.34; 95% CI, 1.26-1.44) with ischemic stroke, and the associations of systolic BP with each subtype of ischemic stroke were modestly attenuated by adjustment for plaque burden. After adjustment for BP, plaque burden had a stronger association with probable large artery stroke (OR, 1.43; 95% CI, 1.24-1.63) than with lacunar stroke (OR, 1.25; 95% CI, 1.10-1.43) but was not associated with probable cardioembolic stroke (OR, 1.06; 95% CI, 0.83-1.36).CONCLUSIONS AND RELEVANCE Although BP was an important risk factor for all ischemic stroke subtypes, carotid atherosclerosis was an important risk factor only for large artery and lacunar strokes, suggesting that drug treatments targeting atherosclerosis may reduce the risk of stroke subtypes to different extents.