心血管健康研究中的无症状性心肌梗死和随后的缺血性卒中。
Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study.
机构信息
From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY.
出版信息
Neurology. 2021 Aug 3;97(5):e436-e443. doi: 10.1212/WNL.0000000000012249. Epub 2021 May 24.
OBJECTIVE
To test the hypothesis that silent myocardial infarction (MI) is a risk factor for ischemic stroke, we evaluated the association between silent MI and subsequent ischemic stroke in the Cardiovascular Health Study.
METHODS
The Cardiovascular Health Study prospectively enrolled community-dwelling individuals ≥65 years of age. We included participants without prevalent stroke or baseline evidence of MI. Our exposures were silent and clinically apparent, overt MI. Silent MI was defined as new evidence of Q-wave MI, without clinical symptoms of MI, on ECGs performed during annual study visits from 1989 to 1999. The primary outcome was incident ischemic stroke. Secondary outcomes were ischemic stroke subtypes: nonlacunar, lacunar, and other/unknown. Cox proportional hazards analysis was used to model the association between time-varying MI status (silent, overt, or no MI) and stroke after adjustment for baseline demographics and vascular risk factors.
RESULTS
Among 4,224 participants, 362 (8.6%) had an incident silent MI, 421 (10.0%) an incident overt MI, and 377 (8.9%) an incident ischemic stroke during a median follow-up of 9.8 years. After adjustment for demographics and comorbidities, silent MI was independently associated with subsequent ischemic stroke (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.03-2.21). Overt MI was associated with ischemic stroke both in the short term (HR, 80; 95% CI, 53-119) and long term (HR, 1.60; 95% CI, 1.04-2.44). In secondary analyses, the association between silent MI and stroke was limited to nonlacunar ischemic stroke (HR, 2.40; 95% CI, 1.36-4.22).
CONCLUSION
In a community-based sample, we found an association between silent MI and ischemic stroke.
目的
为了验证无症状性心肌梗死（MI）是缺血性卒中的危险因素这一假说，我们评估了心血管健康研究中无症状性 MI 与随后发生的缺血性卒中之间的关系。
方法
心血管健康研究前瞻性地招募了年龄在 65 岁及以上的社区居民。我们纳入了无首发卒中或基线 MI 证据的参与者。我们的暴露因素为无症状性和有症状性、显性 MI。无症状性 MI 的定义为在 1989 年至 1999 年期间的年度研究访问期间进行的心电图上出现新的 Q 波 MI 证据，而无 MI 的临床症状。主要结局是首发缺血性卒中。次要结局为缺血性卒中亚型：非腔隙性、腔隙性和其他/未知。使用 Cox 比例风险分析模型，在校正基线人口统计学和血管危险因素后，对随时间变化的 MI 状态（无症状性、显性或无 MI）与卒中之间的关系进行建模。
结果
在 4224 名参与者中，362 名（8.6%）发生了无症状性 MI 事件，421 名（10.0%）发生了显性 MI 事件，377 名（8.9%）发生了缺血性卒中事件，中位随访时间为 9.8 年。在校正人口统计学和合并症后，无症状性 MI 与随后发生的缺血性卒中独立相关（风险比 [HR]，1.51；95%置信区间 [CI]，1.03-2.21）。显性 MI 不仅在短期内（HR，80；95%CI，53-119）而且在长期（HR，1.60；95%CI，1.04-2.44）都与缺血性卒中相关。在二次分析中，无症状性 MI 与卒中的相关性仅限于非腔隙性缺血性卒中（HR，2.40；95%CI，1.36-4.22）。
结论
在一项基于社区的样本中，我们发现无症状性 MI 与缺血性卒中之间存在关联。
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