Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Gyeonggi-do, South Korea.
Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, South Korea.
PLoS One. 2021 May 17;16(5):e0251851. doi: 10.1371/journal.pone.0251851. eCollection 2021.
The purpose of this longitudinal follow-up study was to investigate the risk of ischemic stroke nationwide in patients with seropositive rheumatoid arthritis (RA) and controls who were matched in age and sex. Patient data were collected from the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. Using the International Classification of Diseases code M05 (seropositive RA), with a prescription of any disease-modifying anti-rheumatic drug (DMARD), RA was identified. A total of 2,765 patients and 13,825 control subjects were included in our study. The 12-year incidence of ischemic stroke in each group was calculated using the Kaplan-Meier method. The risk ratio of ischemic stroke was estimated using Cox proportional hazards regression. Sixty-four patients (2.31%) in the seropositive RA group and 512 (3.70%) in the control group experienced ischemic stroke (P < 0.001) during the follow-up period. The hazard ratio of ischemic stroke in the seropositive RA group was 1.32 (95% confidence interval (CI), 1.02-1.73) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the seropositive RA group was 1.40 (95% CI, 1.07-1.82) after adjusting for demographics and comorbid medical disorders. According to the subgroup analysis, the hazard ratios of ischemic stroke risks in the female and hypertensive subgroups were 1.44 (95% CI, 1.05-1.97) and 1.66 (95% CI, 1.16-2.38), respectively. In the non-diabetes and non-dyslipidemia subgroups, the corresponding hazard ratios of ischemic stroke were 1.47 (95% CI, 1.11-1.95) and 1.43 (95% CI, 1.07-1.91). Seropositive RA patients have an increased risk of ischemic stroke. In female, hypertension, non-diabetes, and non-dyslipidemia RA subgroups, even without the traditional risk factors for stroke (except for hypertension), increased the risk, which could be potentially attributed to RA.
本纵向随访研究的目的是调查全国血清阳性类风湿关节炎（RA）患者和年龄、性别匹配的对照组患者发生缺血性卒中的风险。患者数据来自国家健康保险服务（NHIS）健康筛查（HEALS）队列。使用国际疾病分类代码 M05（血清阳性 RA）和任何疾病修饰抗风湿药物（DMARD）的处方来确定 RA。本研究共纳入 2765 例患者和 13825 例对照组。采用 Kaplan-Meier 法计算每组缺血性卒中的 12 年发生率。使用 Cox 比例风险回归估计缺血性卒中的风险比。在随访期间，血清阳性 RA 组有 64 例（2.31%）和对照组有 512 例（3.70%）发生缺血性卒中（P < 0.001）。血清阳性 RA 组发生缺血性卒中的风险比为 1.32（95%置信区间[CI]，1.02-1.73），校正年龄和性别后。在校正人口统计学和合并症后，血清阳性 RA 组发生缺血性卒中的调整风险比为 1.40（95%CI，1.07-1.82）。根据亚组分析，女性和高血压亚组发生缺血性卒中风险的危险比分别为 1.44（95%CI，1.05-1.97）和 1.66（95%CI，1.16-2.38）。在非糖尿病和非血脂异常亚组中，缺血性卒中的相应危险比为 1.47（95%CI，1.11-1.95）和 1.43（95%CI，1.07-1.91）。血清阳性 RA 患者发生缺血性卒中的风险增加。在女性、高血压、非糖尿病和非血脂异常 RA 亚组中，即使没有卒中的传统危险因素（除高血压外），风险也会增加，这可能归因于 RA。
