Department of Radiology, University of Utah, Salt Lake City, Utah, USA,
Department of Biostatistics, University of Utah, Salt Lake City, Utah, USA.
Cerebrovasc Dis Extra. 2021;11(1):37-43. doi: 10.1159/000514373. Epub 2021 Feb 18.
Current ischemic stroke risk prediction is primarily based on clinical factors, rather than imaging or laboratory markers. We examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary ischemic stroke risk.
In this secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), the primary outcome is the incident ischemic stroke during follow-up. The predictor variables are 9 carotid ultrasound-derived measurements and 6 serum inflammation measurements from the baseline study visit. We fit Cox regression models to the outcome of ischemic stroke. The baseline model included patient age, hypertension, diabetes, total cholesterol, smoking, and systolic blood pressure. Goodness-of-fit statistics were assessed to compare the baseline model to a model with ultrasound and inflammation predictor variables that remained significant when added to the baseline model.
We included 5,918 participants. The primary outcome of ischemic stroke was seen in 105 patients with a mean follow-up time of 7.7 years. In the Cox models, we found that carotid distensibility (CD), carotid stenosis (CS), and serum interleukin-6 (IL-6) were associated with incident stroke. Adding tertiles of CD, IL-6, and categories of CS to a baseline model that included traditional clinical vascular risk factors resulted in a better model fit than traditional risk factors alone as indicated by goodness-of-fit statistics.
In a multiethnic cohort of patients without cerebrovascular disease at baseline, we found that CD, CS, and IL-6 helped predict the occurrence of primary ischemic stroke. Future research could evaluate if these basic ultrasound and serum measurements have implications for primary prevention efforts or clinical trial inclusion criteria.
目前的缺血性中风风险预测主要基于临床因素，而不是影像学或实验室标志物。我们研究了基线超声和炎症测量值与随后的原发性缺血性中风风险之间的关系。
在这项多民族动脉粥样硬化研究（MESA）的二次分析中，主要结局是随访期间发生的缺血性中风。预测变量是 9 个颈动脉超声衍生测量值和基线研究访视时的 6 个血清炎症测量值。我们拟合了 Cox 回归模型来预测缺血性中风的结果。基线模型包括患者年龄、高血压、糖尿病、总胆固醇、吸烟和收缩压。通过比较基线模型和基线模型中添加了具有统计学意义的超声和炎症预测变量的模型，评估了拟合优度统计数据。
我们纳入了 5918 名参与者。105 名患者发生了主要结局缺血性中风，平均随访时间为 7.7 年。在 Cox 模型中，我们发现颈动脉可扩张性（CD）、颈动脉狭窄（CS）和血清白细胞介素-6（IL-6）与中风事件有关。将 CD、IL-6 和 CS 三分位数添加到包含传统临床血管危险因素的基线模型中，与仅使用传统危险因素相比，模型拟合度更好，这表明模型拟合度更好。
在一个基线时无脑血管疾病的多民族队列中，我们发现 CD、CS 和 IL-6 有助于预测原发性缺血性中风的发生。未来的研究可以评估这些基本的超声和血清测量值是否对一级预防措施或临床试验纳入标准有影响。
