口服双膦酸盐与缺血性卒中风险：一项病例对照研究。
Oral bisphosphonates and risk of ischemic stroke: a case-control study.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8240 Aarhus N, Denmark.
出版信息
Osteoporos Int. 2011 Jun;22(6):1773-9. doi: 10.1007/s00198-010-1395-y. Epub 2010 Oct 13.
UNLABELLED
Bisphosphonates have been associated with an increased risk of atrial fibrillation and may thus be associated with an increased risk of ischemic stroke. This would have substantial clinical and public health implications. We found no evidence of an association between bisphosphonate use and risk of ischemic stroke.
INTRODUCTION
Bisphosphonates have been associated with an increased risk of atrial fibrillation in some studies and may be associated with an increased risk of ischemic stroke. However, data regarding these possibilities are limited.
METHODS
We conducted a population-based case-control study of 6,257 female cases of ischemic stroke and 31,285 age- and gender-matched population controls. Data on bisphosphonate use, other medication use, comorbidity, and ischemic stroke were obtained from medical databases. Current bisphosphonate use was defined as at least one redeemed prescription within 90 days before diagnosis/index date. We estimated the odds ratio (OR) of ischemic stroke among users and nonusers of bisphosphonates using conditional logistic regression, controlling for potential confounding factors.
RESULTS
One hundred eighty-two (2.9%) cases and 901 (2.9%) controls were current users of bisphosphonates. Etidronate and alendronate were prescribed with similar frequency among cases and controls. The adjusted OR of ischemic stroke for bisphosphonate users compared with nonusers was 0.97 (95% confidence interval [CI], 0.82-1.15). New and continuing bisphosphonate users had adjusted ORs for ischemic stroke of 1.16 (95% CI, 0.69-1.96) and 0.97 (95% CI, 0.81-1.16), respectively. Excluding patients with known atrial fibrillation/flutter yielded an OR of 1.00 (95% CI, 0.85-1.19). The OR for ischemic stroke was 0.59 (95% CI, 0.32-1.09) among patients with a history of previous hospitalization for cardiovascular disease and 1.07 (95% CI, 0.88-1.18) among those without (P < 0.001). The OR for former users was 1.23 (95% CI, 1.01-1.49).
CONCLUSION
We found no evidence of an association of oral bisphosphonate use with the risk of ischemic stroke.
目的
双膦酸盐与心房颤动风险增加相关，可能与缺血性卒中风险增加相关。这将具有重大的临床和公共卫生意义。我们未发现双膦酸盐使用与缺血性卒中风险之间存在关联的证据。
引言
一些研究表明双膦酸盐与心房颤动风险增加相关，且可能与缺血性卒中风险增加相关。然而，关于这些可能性的数据有限。
方法
我们开展了一项基于人群的病例对照研究，纳入了 6257 例女性缺血性卒中病例和 31285 名年龄和性别匹配的人群对照。双膦酸盐使用、其他药物使用、合并症和缺血性卒中数据来自医疗数据库。当前双膦酸盐使用者定义为在诊断/索引日期前 90 天内至少有 1 次处方配药。我们使用条件逻辑回归，控制潜在混杂因素，估计双膦酸盐使用者与非使用者发生缺血性卒中的比值比（OR）。
结果
182 例（2.9%）病例和 901 例（2.9%）对照为当前双膦酸盐使用者。依替膦酸二钠和阿仑膦酸钠在病例和对照中的使用频率相似。与非使用者相比，双膦酸盐使用者发生缺血性卒中的调整 OR 为 0.97（95%置信区间[CI]，0.82-1.15）。新使用者和持续使用者发生缺血性卒中的调整 OR 分别为 1.16（95%CI，0.69-1.96）和 0.97（95%CI，0.81-1.16）。排除已知心房颤动/扑动的患者后，OR 为 1.00（95%CI，0.85-1.19）。既往有心血管疾病住院史患者的 OR 为 0.59（95%CI，0.32-1.09），无心血管疾病住院史患者的 OR 为 1.07（95%CI，0.88-1.18）（P＜0.001）。前使用者的 OR 为 1.23（95%CI，1.01-1.49）。
结论
我们未发现口服双膦酸盐使用与缺血性卒中风险之间存在关联。
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