National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Consortium for Biomedical Research in Epidemiology and Public Health Madrid, Madrid, Spain.
Drug Alcohol Rev. 2018 Jan;37(1):56-69. doi: 10.1111/dar.12559. Epub 2017 May 8.
Amphetamine-type stimulants (ATS) are a putative cause of stroke with high abuse potential. We aim to systematically review the association between use of ATS and stroke.
To assure a sensitive search strategy, a broad definition of ATS was used. Cochrane Plus, EMBASE, IBECS/Lilacs, ISI WOK, Medline and Scopus were searched through 2016. Three researchers independently reviewed studies (Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-analyses). Validity and bias were appraised.
Of 3998 articles, four cohort studies and eight case-control studies (CCS) were selected; 11 focused on prescribed or over-the-counter ATS. Current ATS users showed a higher ischaemic stroke risk than non-users in two cohort studies {adjusted rate ratio = 1.6 [95% confidence interval (CI) = 1.1, 2.4] and 3.4 [95% CI = 1.1, 10.6]}. One study observed increased risk of haemorrhagic stroke in former users versus non-users [adjusted rate ratio = 2.3 (95% CI = 1.3, 4.1)]. Higher haemorrhagic stroke risk was seen in two CCS among women using ATS [adjusted odds ratio (aOR) = 16.6 (95% CI = 1.5, 182.2) and 3.9 (95% CI = 1.1, 13.1)]. All-stroke was negatively associated with ATS in another CCS [aOR = 0.4 (95% CI = 0.2, 0.8)] and positively associated in the only study on non-medical ATS [aOR = 3.8 (95% CI = 1.2, 12.6)]. Selection bias and uncontrolled confounding were common.
This is the first systematic review on ATS and stroke. Limited epidemiological evidence suggests that ATS use increases stroke risk. Possible disparities in ATS effect across stroke type and higher effect in women deserve further clarification. Studies on non-medical ATS use should be a priority. [Indave BI, Sordo L, Bravo MJ, Sarasa-Renedo A, Fernández-Balbuena S, De la Fuente L, Sonego M, Barrio G. Risk of stroke in prescription and other amphetamine-type stimulants use: A systematic review. Drug Alcohol Rev 2018;37:56-69].
苯丙胺类兴奋剂（ATS）具有较高的滥用潜力，被认为是中风的一个潜在原因。我们旨在系统地综述使用 ATS 与中风之间的关联。
为确保敏感的搜索策略，使用了广泛的 ATS 定义。通过 Cochrane Plus、EMBASE、IBECS/Lilacs、ISI WOK、Medline 和 Scopus 搜索了 2016 年之前的文献。三位研究人员独立审查了研究（观察性研究的流行病学荟萃分析和系统评价和荟萃分析的首选报告项目）。评估了有效性和偏倚。
在 3998 篇文章中，选择了四项队列研究和八项病例对照研究（CCS）；其中 11 项研究集中于处方或非处方 ATS。两项队列研究显示，当前使用 ATS 的患者与非使用者相比，缺血性中风风险更高[调整后的发病率比=1.6（95%置信区间[CI]：1.1，2.4）和 3.4（95%CI：1.1，10.6）]。一项研究观察到，与非使用者相比，前使用者的出血性中风风险增加[调整后的发病率比=2.3（95%CI：1.3，4.1）]。在两项 CCS 中，女性使用 ATS 出血性中风风险更高[调整后的优势比（aOR）=16.6（95%CI：1.5，182.2）和 3.9（95%CI：1.1，13.1）]。另一项 CCS 研究表明，全因中风与 ATS 呈负相关[aOR=0.4（95%CI：0.2，0.8）]，而唯一一项关于非医疗用 ATS 的研究表明，全因中风与 ATS 呈正相关[aOR=3.8（95%CI：1.2，12.6）]。选择偏倚和未控制的混杂因素很常见。
这是关于 ATS 和中风的首次系统综述。有限的流行病学证据表明，ATS 使用增加了中风风险。中风类型和女性中风风险可能存在差异，需要进一步澄清。关于非医疗用 ATS 使用的研究应是当务之急。
