Cocaine Use and Risk of Ischemic Stroke in Young Adults.
Cocaine Use and Risk of Ischemic Stroke in Young Adults.
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DOI：
10.1161/strokeaha.115.011417
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发表时间：
2016-04
期刊：
影响因子：
8.3
通讯作者：
Kittner SJ
中科院分区：
文献类型：
--
作者：
Cheng YC;Ryan KA;Qadwai SA;Shah J;Sparks MJ;Wozniak MA;Stern BJ;Phipps MS;Cronin CA;Magder LS;Cole JW;Kittner SJ
尽管病例报告早已确定可卡因使用与缺血性卒中之间存在时间相关性，但很少有流行病学研究通过使用时间、途径和频率研究可卡因使用与年轻人缺血性卒中之间的相关性。一项基于人群的病例对照研究设计，包括1,090例病例和1,154例对照，用于调查可卡因使用与缺血性卒中的关系。中风病例年龄在15岁至49岁之间。Logistic回归分析用于评估可卡因使用与缺血性卒中之间的相关性，调整和不调整潜在的混杂因素。曾经使用可卡因与中风无关，28%的病例和26%的对照组报告曾经使用可卡因。相比之下，24小时内急性使用可卡因与卒中风险增加密切相关（年龄-性别-种族调整OR = 6.4，95%CI =2.2 - 18.6）。在急性使用者中，吸烟途径的校正比值比为7.9（95% CI=1.8 - 35.0），而吸入途径的校正比值比为3.5（95% CI=0.7 - 16.9）。在对当前饮酒、吸烟和高血压进行额外调整后，任何途径急性可卡因使用的比值比为5.7（95% CI =1.7，19.7）。在中风后24小时内使用可卡因的26名患者中，14名在事件发生后6小时内报告使用。我们的数据与急性可卡因使用和早发性缺血性卒中风险之间的因果关系一致。
Although case reports have long identified a temporal association between cocaine use and ischemic stroke, few epidemiological studies have examined the association of cocaine use with ischemic stroke in young adults, by timing, route and frequency of use. A population-based case-control study design with 1,090 cases and 1,154 controls was used to investigate the relationship of cocaine use and young-onset ischemic stroke. Stroke cases were between the ages of 15 and 49. Logistic regression analysis was used to evaluate the association between cocaine use and ischemic stroke with and without adjustment for potential confounders. Ever use of cocaine was not associated with stroke with 28% of cases and 26% of controls reporting ever use. In contrast, acute cocaine use in the prior 24 hours was strongly associated with increased risk of stroke (age-sex-race adjusted OR = 6.4, 95% CI=2.2 - 18.6). Among acute users, the smoking route had an adjusted odds ratio of 7.9 (95% CI=1.8 – 35.0), while the inhalation route had an adjusted odds ratio of 3.5 (95% CI=0.7 – 16.9). After additional adjustment for current alcohol, smoking use and hypertension, the odds ratio for acute cocaine use by any route was 5.7 (95% CI =1.7, 19.7). Of the 26 patients with cocaine use within 24 hours of their stroke, 14 reported use within 6 hours of their event. Our data are consistent with a causal association between acute cocaine use and risk of early-onset ischemic stroke.