Witt Brandi J, Brown Robert D, Jacobsen Steven J, Weston Susan A, Ballman Karla V, Meverden Ryan A, Roger Véronique L
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN, USA.
Am Heart J. 2006 Jul;152(1):102-9. doi: 10.1016/j.ahj.2005.10.018.
Although studies have examined the incidence of stroke in heart failure (HF), their findings are inconsistent and difficult to interpret because of heterogeneity in study design and population. Although HF remains a highly fatal disease, the excess mortality imparted from stroke is unknown.
A random sample of cases of HF from 1979 to 1999 was identified and validated according to Framingham criteria. Strokes were identified by screening medical diagnoses and subsequent physician validation. Stroke risk in HF was compared with the risk in the general population with standardized morbidity ratios. Associations between selected characteristics and stroke were examined using proportional hazards regression.
The study cohort included 630 persons with incident HF. During a median of 4.3 years of follow-up, 102 (16%) experienced an ischemic stroke. Heart failure was associated with a 17.4-fold increased risk for stroke compared with the general population in the first 30 days after HF diagnosis and remained elevated during 5 years of follow-up. Older persons with prior stroke or diabetes were more likely to experience stroke after HF diagnosis. Persons with stroke after HF were 2.31 times more likely to die compared with persons without stroke.
In the community, persons with HF have a large increase in the risk for ischemic stroke compared with the general population. Stroke results in a >2-fold increase in mortality. Thus, prevention of stroke has the potential to improve survival among patients with HF, particularly among the elderly and those with diabetes or prior stroke.
尽管已有研究对心力衰竭（HF）患者中风的发病率进行了考察，但由于研究设计和人群的异质性，其结果并不一致且难以解读。尽管HF仍然是一种高致死性疾病，但中风导致的额外死亡率尚不清楚。
根据弗雷明汉标准，对1979年至1999年HF病例的随机样本进行识别和验证。通过筛查医学诊断结果并经医生后续确认来识别中风。采用标准化发病比，将HF患者的中风风险与普通人群的风险进行比较。使用比例风险回归分析选定特征与中风之间的关联。
研究队列包括630例新发HF患者。在中位随访4.3年期间，102例（16%）发生了缺血性中风。与普通人群相比，HF诊断后的前30天内，HF与中风风险增加17.4倍相关，且在5年随访期间一直保持较高水平。既往有中风或糖尿病的老年人在HF诊断后更易发生中风。HF后发生中风的患者死亡可能性是未发生中风患者的2.31倍。
在社区中，与普通人群相比，HF患者发生缺血性中风的风险大幅增加。中风导致死亡率增加2倍以上。因此，预防中风有可能改善HF患者的生存率，尤其是老年患者以及患有糖尿病或既往有中风史的患者。
