Subramanian G, Silva J, Silver F L, Fang J, Kapral M K, Oczkowski W, Gould L, O'Donnell M J
McMaster University, Hamilton, Ontario, Canada.
Neuroepidemiology. 2009;33(1):12-6. doi: 10.1159/000209282. Epub 2009 Mar 20.
Traditional vascular risk factors appear to exert varying magnitudes of risk for different major vascular events. For example, hypercholesterolemia is a much stronger risk factor for myocardial infarction than ischemic stroke. Limited evidence also suggests that vascular risk factors may exert differing magnitudes of risk for ischemic stroke within different cerebral arterial territories. We sought to determine the association between traditional vascular risk factors and the location of ischemic stroke (posterior versus anterior).
Consecutive patients with acute ischemic stroke who were admitted to 11 regional stroke centers within the Registry of the Canadian Stroke Network were included in the study sample. The Oxfordshire Community Stroke Project classification was used to distinguish posterior from anterior circulation ischemic stroke. Multivariable logistic regression was applied to determine the association between risk factors (age, gender, diabetes mellitus, hypercholesterolemia, hypertension, atrial fibrillation and smoking history) and posterior (compared to anterior) circulation ischemic stroke.
In total, 8,489 patients with acute ischemic stroke were included. On multivariable analysis, diabetes mellitus (OR = 1.14; 95% CI = 1.02-1.27) was associated with an increased odds of posterior circulation ischemic stroke, whereas age (OR = 0.86; 95% CI = 0.83-0.90), female sex (OR = 0.84; 95% CI = 0.76-0.93), atrial fibrillation (OR = 0.83; 95% CI = 0.74-0.94) and pulmonary edema (OR = 0.74; 95% CI = 0.62-0.88) were related to a reduced odds of posterior compared with anterior circulation ischemic stroke.
Some traditional vascular risk factors for ischemic stroke appear to exert different magnitudes of risk for posterior compared to anterior circulation ischemic stroke.
传统血管危险因素似乎对不同的主要血管事件产生不同程度的风险。例如，高胆固醇血症是心肌梗死比缺血性中风更强的危险因素。有限的证据还表明，血管危险因素在不同脑动脉区域对缺血性中风可能产生不同程度的风险。我们试图确定传统血管危险因素与缺血性中风部位（后循环与前循环）之间的关联。
纳入加拿大卒中网络登记处11个地区性卒中中心收治的急性缺血性中风连续患者作为研究样本。采用牛津郡社区卒中项目分类法区分后循环与前循环缺血性中风。应用多变量逻辑回归分析确定危险因素（年龄、性别、糖尿病、高胆固醇血症、高血压、心房颤动和吸烟史）与后循环（与前循环相比）缺血性中风之间的关联。
共纳入8489例急性缺血性中风患者。多变量分析显示，糖尿病（比值比=1.14；95%置信区间=1.02-1.27）与后循环缺血性中风几率增加相关，而年龄（比值比=0.86；95%置信区间=0.83-0.90）、女性（比值比=0.84；95%置信区间=0.76-0.93）、心房颤动（比值比=0.83；95%置信区间=0.74-0.94）和肺水肿（比值比=0.74；95%置信区间=0.62-0.88）与后循环缺血性中风几率降低相关（与前循环相比）。
一些缺血性中风的传统血管危险因素对后循环缺血性中风与前循环缺血性中风似乎产生不同程度的风险。
