Department of Psychiatry (M.-H.C., S.-J.T., T.-P.S., C.-T.L., W.-C.L., Y.-M.B.), Taipei Veterans General Hospital, Taiwan.
Department of Psychiatry, College of Medicine (M.-H.C., S.-J.T., T.-P.S., C.-T.L., W.-C.L., Y.-M.B.), National Yang Ming Chiao Tung University, Taipei, Taiwan.
Stroke. 2021 Aug;52(8):2601-2608. doi: 10.1161/STROKEAHA.120.032995. Epub 2021 May 27.
Patients with obsessive-compulsive disorder (OCD) tend to be comorbid with stroke-related risk factors, including obesity, hypertension, and diabetes. However, the temporal association between OCD and subsequent stroke risk is unclear.
Using data collected between 2001 and 2010 by Taiwan’s National Health Insurance Research Database, 28 064 adult patients with OCD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code: 300.3) and 28 064 age-, sex-, and comorbidity-matched controls were included in this study. Patients who developed ischemic (ICD-9-CM codes: 433, 434, and 435) and hemorrhagic (ICD-9-CM codes: 430, 431, and 432) stroke during follow-up (from enrollment to end of 2011) were identified. Moreover, medications used for treating OCD were assessed.
Patients with OCD (hazard ratio [HR], 3.02 [95% CI, 1.91–4.77]), especially middle-aged (HR, 2.66 [95% CI, 1.34–5.29]) and elderly adults (HR, 3.46 [95% CI, 1.70–7.05]), had an elevated risk of developing ischemic stroke during the follow-up period compared with non-OCD controls. The cumulative HR of hemorrhagic stroke did not differ (HR, 0.87 [95% CI, 0.42–1.80]) between the OCD and non-OCD groups. In patients with OCD, both short- (HR, 1.69 [95% CI, 0.74–3.88]; HR, 0.31 [95% CI, 0.05–1.95]) and long-term use (HR, 1.37 [95% CI, 0.60–3.16]; HR, 0.90 [95% CI, 0.22–3.76]) of OCD medications were not correlated with ischemic and hemorrhagic stroke compared with nonuse.
Clinicians should closely monitor cerebrovascular disease and related risks in patients with OCD. The pathomechanism of OCD with an increased risk of ischemic stroke warrants further investigation.
强迫症（OCD）患者往往与中风相关的风险因素共病，包括肥胖、高血压和糖尿病。然而，OCD 与随后中风风险之间的时间关联尚不清楚。
使用 2001 年至 2010 年期间由台湾全民健康保险研究数据库收集的数据，本研究纳入了 28064 例 OCD 成年患者（国际疾病分类，第九版，临床修订版[ICD-9-CM]代码：300.3）和 28064 例年龄、性别和合并症匹配的对照者。在随访期间（从登记到 2011 年底），确定了发生缺血性（ICD-9-CM 代码：433、434 和 435）和出血性（ICD-9-CM 代码：430、431 和 432）中风的患者。此外，评估了用于治疗 OCD 的药物。
与非 OCD 对照组相比，OCD 患者（风险比[HR]，3.02[95%CI，1.91-4.77]），尤其是中年（HR，2.66[95%CI，1.34-5.29]）和老年患者（HR，3.46[95%CI，1.70-7.05]），在随访期间发生缺血性中风的风险升高。OCD 和非 OCD 组之间，出血性中风的累积 HR 无差异（HR，0.87[95%CI，0.42-1.80]）。在 OCD 患者中，短期（HR，1.69[95%CI，0.74-3.88]；HR，0.31[95%CI，0.05-1.95]）和长期（HR，1.37[95%CI，0.60-3.16]；HR，0.90[95%CI，0.22-3.76]）使用 OCD 药物与缺血性和出血性中风无关。
临床医生应密切监测 OCD 患者的脑血管疾病和相关风险。OCD 风险增加导致缺血性中风的发病机制需要进一步研究。
