Flossmann Enrico, Rothwell Peter M
Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.
Stroke. 2005 Apr;36(4):830-5. doi: 10.1161/01.STR.0000158920.67013.53. Epub 2005 Mar 3.
Family history of stroke (FHx(stroke)) is a risk factor for ischemic stroke, but there are insufficient data on the relationship with stroke subtypes and intermediate phenotypes (IPs), such as hypertension. Specifically, there are no reliable data on the associations of FHx(stroke) in patients with transient ischemic attack (TIA) in whom relationships with IPs are likely to be determined most reliably.
We studied FHx(stroke) and FHx of myocardial infarction (FHx(MI)) in TIA patients from 2 population-based incidence studies and 2 prospective consecutive hospital-referred series. We related the presence of FHx to baseline characteristics, clinical subtype, and IPs.
Results were similar in the 4 cohorts, and so data on all 783 patients were pooled. FHx(stroke) was less common than FHx(MI) (189 versus 254; P=0.0003). FHx(stroke) and FHx(MI) were strongly related to history of hypertension in the proband (odds ratio [OR], 1.78; 95% CI, 1.28 to 2.48; P=0.0008; and OR, 2.10, 95% CI, 1.55 to 2.85; P<0.0001, respectively). Highest recorded premorbid systolic and diastolic blood pressures (mm Hg) were significantly higher in cases with FHx(stroke) than those without and increased with the number of affected first-degree relatives (0 181/100; 1 185/104; > or =2 198/109; P=0.03). There was no association between FHx(stroke) and age, diabetes, smoking, plasma glucose, cholesterol, or territory of TIA, but FHx(stroke) was less common in patients with ocular TIA than in cases with cerebral TIA (OR, 0.53; 95% CI, 0.34 to 0.82; P=0.004), although the association was no longer significant after adjustment for hypertension.
The strong association between hypertension and FHx(stroke) suggests that familial susceptibility to cerebral ischemia is attributable, at least partly, to familial predisposition to hypertension. This should be taken into account in studies of the genetics of ischemic stroke.
卒中家族史（FHx（卒中））是缺血性卒中的一个危险因素，但关于其与卒中亚型及诸如高血压等中间表型（IPs）之间关系的数据并不充分。具体而言，在短暂性脑缺血发作（TIA）患者中，关于FHx（卒中）的关联尚无可靠数据，而TIA患者与IPs之间的关系可能最易于可靠判定。
我们在两项基于人群的发病率研究及两项前瞻性连续医院转诊系列研究中，对TIA患者的FHx（卒中）及心肌梗死家族史（FHx（心肌梗死））进行了研究。我们将FHx的存在情况与基线特征、临床亚型及IPs进行了关联分析。
4个队列的结果相似，因此将所有783例患者的数据进行了汇总。FHx（卒中）比FHx（心肌梗死）少见（189例对254例；P = 0.0003）。FHx（卒中）和FHx（心肌梗死）与先证者的高血压病史密切相关（优势比[OR]分别为1.78；95%可信区间[CI]为1.28至2.48；P = 0.0008；以及OR为2.10，95%CI为1.55至2.85；P < 0.0001）。有FHx（卒中）的患者病前最高收缩压和舒张压（mmHg）显著高于无FHx（卒中）者，且随受影响的一级亲属数量增加而升高（0例时为181/100；1例时为185/104；≥2例时为198/109；P = 0.03）。FHx（卒中）与年龄（岁）、糖尿病、吸烟、血糖、胆固醇或TIA的发病部位之间无关联，但眼部TIA患者的FHx（卒中）比脑部TIA患者少见（OR为0.53；95%CI为0.34至0.82；P = 0.004），尽管在对高血压进行校正后该关联不再显著。
高血压与FHx（卒中）之间的强关联表明，家族性脑缺血易感性至少部分归因于家族性高血压易感性。在缺血性卒中遗传学研究中应考虑到这一点。
