1 Department of Epidemiology.
2 Department of Neurology.
Am J Respir Crit Care Med. 2016 Feb 1;193(3):251-8. doi: 10.1164/rccm.201505-0962OC.
Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD.
To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations.
Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model.
COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00-1.43), ischemic stroke (HR, 1.27; 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 1.01-2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91-1.31) for all stroke; HR, 1.13 (0.91-1.42) for ischemic stroke; and HR 1.53 (0.91-2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42-18.20) increased risk of stroke.
Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
在全球范围内，慢性阻塞性肺疾病（COPD）和中风是主要的死亡原因。越来越多的证据表明，这两种疾病之间存在关联，要么是由于 COPD 患者的动脉粥样硬化风险增加所致，要么是由于中风和 COPD 之间存在共同的危险因素所致。
在一般人群中研究 COPD 与中风各亚型之间的关联，并探讨心血管危险因素和加重因素在这些关联中的作用。
在前瞻性人群为基础的鹿特丹研究中，我们随访了 13115 名无中风病史的参与者，以观察中风的发生情况。随访始于 1990 年至 2008 年，于 2012 年结束。使用时间依赖性 Cox 比例风险模型将 COPD 与中风相关联。
1566 名参与者被诊断为 COPD。在 126347 人年中，有 1250 名参与者发生了中风，其中 701 例为缺血性中风，107 例为出血性中风。调整年龄、年龄平方和性别后，COPD 与所有中风（风险比 [HR]，1.20；95%置信区间，1.00-1.43）、缺血性中风（HR，1.27；1.02-1.59）和出血性中风（HR，1.70；1.01-2.84）显著相关。调整心血管危险因素后，得到了相似的效应大小。相比之下，进一步调整吸烟因素会减弱效应大小：所有中风的 HR 为 1.09（0.91-1.31）；缺血性中风的 HR 为 1.13（0.91-1.42）；出血性中风的 HR 为 1.53（0.91-2.59）。在急性严重加重后，COPD 患者发生中风的风险增加了 6.66 倍（2.42-18.20）。
我们的队列研究表明，COPD 患者发生缺血性和出血性中风的风险较高，并揭示了吸烟作为共同危险因素的重要性。
