Department of Epidemiology and Public Health, Inserm U744, Institut Pasteur de Lille, 1, Rue du Professeur Calmette, BP245, 59019 Lille Cedex, France.
Circulation. 2011 Apr 12;123(14):1537-44. doi: 10.1161/CIRCULATIONAHA.110.000125. Epub 2011 Mar 28.
Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study.
The study sample comprised 690 CEAD patients (mean age, 44.2 ± 9.9 years; 43.9% women), 556 patients with a non-CEAD IS (44.7 ± 10.5 years; 39.9% women), and 1170 referents (45.9 ± 8.1 years; 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index ≥ 30 kg/m²) or overweightness (body mass index ≥ 25 kg/m² and <30 kg/m²) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55; 95% confidence interval, 0.42 to 0.71; P<0.0001), obesity (odds ratio 0.37; 95% confidence interval, 0.26 to 0.52; P<0.0001), and overweightness (odds ratio 0.70; 95% confidence interval, 0.57 to 0.88; P=0.002) but were more frequently hypertensive (odds ratio 1.67; 95% confidence interval, 1.32 to 2.1; P<0.0001). All vascular risk factors were less frequent in CEAD patients compared with young patients with a non-CEAD IS. The latter were more frequently hypertensive, diabetic, and current smokers compared with referents.
These results, from the largest series to date, suggest that hypertension, although less prevalent than in patients with a non-CEAD IS, could be a risk factor of CEAD, whereas hypercholesterolemia, obesity, and overweightness are inversely associated with CEAD.
颈内动脉夹层（CEAD）是青年缺血性卒中（IS）的主要病因，但其发病风险因素知之甚少。高血压、糖尿病、吸烟、高胆固醇血症和肥胖是 IS 的重要危险因素。然而，其在 CEAD 中的具体作用研究甚少。我们旨在比较多中心颈内动脉夹层和缺血性卒中患者（CADISP）研究中 CEAD 患者与对照组及非 CEAD 病因 IS （非 CEAD-IS）患者的血管危险因素患病率。
研究样本包括 690 例 CEAD 患者（平均年龄 44.2±9.9 岁，43.9%为女性）、556 例非 CEAD-IS 患者（44.7±10.5 岁，39.9%为女性）和 1170 例对照者（45.9±8.1 岁，44.1%为女性）。我们采用多变量逻辑回归比较了 3 组人群中高血压、糖尿病、高胆固醇血症、吸烟和肥胖（体重指数≥30kg/m²）或超重（体重指数≥25kg/m²且<30kg/m²）的患病率，调整了纳入国家、年龄和性别因素。与对照组相比，CEAD 患者高胆固醇血症患病率较低（比值比 0.55；95%置信区间，0.42 至 0.71；P<0.0001）、肥胖（比值比 0.37；95%置信区间，0.26 至 0.52；P<0.0001）和超重（比值比 0.70；95%置信区间，0.57 至 0.88；P=0.002），但高血压更常见（比值比 1.67；95%置信区间，1.32 至 2.1；P<0.0001）。与非 CEAD-IS 青年患者相比，所有血管危险因素在 CEAD 患者中均较少见。后者高血压、糖尿病和现吸烟者较对照组更常见。
这些结果来自迄今为止最大的系列研究，提示高血压虽然较非 CEAD-IS 患者少见，但可能是 CEAD 的危险因素，而高胆固醇血症、肥胖和超重与 CEAD 呈负相关。
