Owolabi M O, Akpa O M, Agunloye A M
Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Acta Neurol Scand. 2016 Jun;133(6):442-50. doi: 10.1111/ane.12482. Epub 2015 Sep 10.
It is unclear whether a natural marker of atherosclerosis (carotid intima-media thickness: CIMT) or calculated risk score is more associated with stroke. We therefore comparatively examined the relationship between CIMT as well as two cardiovascular risk calculators (Omnibus Risk Score -ORS and Framingham Risk Score- FRS) and the occurrence of stroke among hypertensive African patients.
CIMT was measured in 555 consecutive consenting hypertensive adults (377 stroke patients and 178 stroke-free subjects). The 10-year cardiovascular risk was calculated for each participant with the FRS and ORS. The strengths of association between FRS, ORS, CIMT, and stroke occurrence were examined using logistic regression. The discriminative capacity of FRS, ORS, and CIMT for stroke occurrence was assessed with c-statistics.
Higher average CIMT (OR 11.71; 95% CI 1.65-83.07; P = 0.01) was strongly associated with stroke after adjusting for age, sex, blood pressure, serum cholesterol, and blood sugar. Neither the FRS (OR: 1.03; CI: 0.89-1.19, P = 0.68) nor the ORS (OR: 1.08; CI: 0.90-1.30; P = 0.41) was significantly associated with stroke. CIMT had a higher c-statistic for differentiating stroke patients from hypertensive controls (right: c = 0.63, P < 0.001; left: c = 0.67, P < 0.001; average: c = 0.66, P < 0.001) than some conventional risk factors. Neither FRS (P = 0.39) nor ORS (P = 0.55) was able to independently differentiate between stroke and hypertensive patients.
CIMT, but neither FRS nor ORS, is independently associated with stroke among Nigerian African hypertensive patients. CIMT may be a better tool for estimating the overall risk of stroke than FRS or ORS in this population.
动脉粥样硬化的自然标志物（颈动脉内膜中层厚度：CIMT）或计算得出的风险评分与中风的关联程度尚不清楚。因此，我们比较研究了CIMT以及两种心血管风险计算器（综合风险评分 - ORS和弗雷明汉风险评分 - FRS）与高血压非洲患者中风发生之间的关系。
对555名连续同意参与的高血压成年患者（377名中风患者和178名无中风受试者）进行CIMT测量。使用FRS和ORS为每位参与者计算10年心血管风险。采用逻辑回归分析FRS、ORS、CIMT与中风发生之间的关联强度。用c统计量评估FRS、ORS和CIMT对中风发生的判别能力。
在调整年龄、性别、血压、血清胆固醇和血糖后，较高的平均CIMT（比值比11.71；95%置信区间1.65 - 83.07；P = 0.01）与中风密切相关。FRS（比值比：1.03；置信区间：0.89 - 1.19，P = 0.68）和ORS（比值比：1.08；置信区间：0.90 - 1.30；P = 0.41）均与中风无显著关联。与一些传统风险因素相比，CIMT在区分中风患者与高血压对照组方面具有更高的c统计量（右侧：c = 0.63，P < 0.001；左侧：c = 0.67，P < 0.001；平均：c = 0.66，P < 0.001）。FRS（P = 0.39）和ORS（P = 0.55）均无法独立区分中风患者和高血压患者。
在尼日利亚非洲高血压患者中，CIMT与中风独立相关，而FRS和ORS则不然。在该人群中，CIMT可能是比FRS或ORS更好的评估中风总体风险的工具。
