Ikram M A, Hollander M, Bos M J, Kors J A, Koudstaal P J, Hofman A, Witteman J C M, Breteler M M B
Department of Epidemiology and Biostatistics, Erasmus Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
Neurology. 2006 Nov 14;67(9):1635-9. doi: 10.1212/01.wnl.0000242631.75954.72.
To investigate the relationship between unrecognized myocardial infarction and the risk of stroke in a population-based cohort study.
We followed 6,439 participants from the Rotterdam Study for stroke until January 2002. Participants were free from stroke, and presence of myocardial infarction was assessed at baseline (1990-1993). We calculated hazard ratios of stroke for persons with unrecognized or recognized myocardial infarction compared with persons without myocardial infarction. Analyses were adjusted for age, sex, and cardiovascular risk factors.
In 52,915 person-years of follow-up, 505 strokes occurred. Recognized myocardial infarction was only borderline associated with an increased risk of stroke. Unrecognized myocardial infarction increased the risk of stroke by 76% (age- and sex-adjusted hazard ratio 1.76, 95% CI 1.31 to 2.37). Stratification by sex showed that the increased risk was only found in men (hazard ratio for men 2.53, 95% CI 1.68 to 3.81; hazard ratio for women 1.27, 95% CI 0.82 to 1.96). After adjusting for cardiovascular risk factors at baseline, the risk remained significantly increased in men (hazard ratio for stroke 2.13, 95% CI 1.35 to 3.36). Subtyping of strokes revealed that unrecognized myocardial infarction was particularly associated with cortical ischemic strokes (hazard ratio for men 3.57, 95% CI 1.79 to 7.12).
Men with unrecognized myocardial infarction have an increased risk of stroke.
在一项基于人群的队列研究中，调查未识别的心肌梗死与中风风险之间的关系。
我们对来自鹿特丹研究的6439名参与者进行随访，直至2002年1月，观察其是否发生中风。参与者在基线时（1990 - 1993年）无中风，且评估了心肌梗死的存在情况。我们计算了未识别或已识别心肌梗死患者与无心肌梗死患者相比的中风风险比。分析对年龄、性别和心血管危险因素进行了校正。
在52915人年的随访中，发生了505例中风。已识别的心肌梗死仅与中风风险增加存在边缘关联。未识别的心肌梗死使中风风险增加了76%（年龄和性别校正后的风险比为1.76，95%可信区间为1.31至2.37）。按性别分层显示，风险增加仅在男性中发现（男性风险比为2.53，95%可信区间为1.68至3.81；女性风险比为1.27，95%可信区间为0.82至1.96）。在对基线时的心血管危险因素进行校正后，男性的风险仍然显著增加（中风风险比为2.13，95%可信区间为1.35至3.36）。中风亚型分析显示，未识别的心肌梗死尤其与皮质缺血性中风相关（男性风险比为3.57，95%可信区间为1.79至7.12）。
未识别心肌梗死的男性中风风险增加。
