Shams Tanzila, Auchus Alexander P, Oparil Suzanne, Wright Clinton B, Wright Jackson, Furlan Anthony J, Sila Cathy A, Davis Barry R, Pressel Sara, Yamal Jose-Miguel, Einhorn Paula T, Lerner Alan J
From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.).
Stroke. 2017 Nov;48(11):3078-3085. doi: 10.1161/STROKEAHA.117.016062. Epub 2017 Sep 27.
The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate.
QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression.
After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups (≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL.
The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
视觉模拟量表是一种经过验证的、用于自我报告生活质量（QoL）的工具。我们的目的是确定在抗高血压和降脂治疗预防心脏病发作试验（ALLHAT研究）中，基线生活质量是否能预测中风，并评估中风后生活质量变化的决定因素。在ALLHAT研究中，随机分配至各治疗组的33357例患者中，有1525例发生中风；1202例（79%）中风为非致命性。本研究队列包括32318例（97%）完成基线视觉模拟量表生活质量评估的受试者。
采用视觉模拟量表测量生活质量，并使用托伦斯转换法进行调整（转换后的生活质量 [TQoL]）。采用Kaplan-Meier曲线和调整后的比例风险分析，以连续量表（0-1）和四分位数（≤0.81、>0.81≤0.89、>0.89≤0.95、>0.95）评估TQoL对中风风险的影响。我们使用调整后的线性回归分析了从基线到首次中风后TQoL的变化。
在调整多个中风危险因素后，基线TQoL每增加0.1个单位，中风事件的风险比为0.93（95%置信区间，0.89-0.98）。与参考的最高四分位数TQoL相比，最低基线TQoL四分位数的中风风险增加20%（风险比=1.20 [95%置信区间，1.00-1.44]）。所有治疗组中风后的TQoL变化均具有显著性（≤0.001）。多变量回归分析显示，基线TQoL是中风后TQoL的最强预测因素，未转换的生活质量也有类似结果。
最低基线TQoL四分位数的中风风险比最高四分位数高20%。基线TQoL是预测中风后TQoL变化的唯一因素。
