Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
Skåne University Hospital, Malmö, Sweden.
BMC Cardiovasc Disord. 2021 Nov 12;21(1):536. doi: 10.1186/s12872-021-02344-4.
Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes.
Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes.
Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE.
CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.
尽管冠心病事件（CE）和缺血性卒中具有许多共同的危险因素，但也存在一些重要的差异。本文旨在评估与冠心病事件和缺血性卒中相关的危险因素之间的关联，并评估两种结局的危险因素模式之间的异质性。
在马尔默饮食与癌症队列（MDCS，n=26519）中测量了与冠心病事件和缺血性卒中相关的传统危险因素和炎症标志物，平均随访时间为 19±6 年，共发生 2270 例缺血性卒中和 3087 例冠心病事件。在心血管亚队列（MDC-CV，n=4795）中与炎症标志物相关。使用 Cox 回归分析获得风险比。采用改良的 Lunn-McNeil 竞争风险分析评估这些结局的风险分布是否存在差异。
大多数心血管危险因素与冠心病事件和缺血性卒中均相关。然而，与缺血性卒中相比，当前吸烟、ApoB、低 ApoA1、男性和教育程度≤9 年与冠心病事件的相关性更强。相反，年龄与缺血性卒中的相关性强于与冠心病事件的相关性。
冠心病事件和缺血性卒中具有广泛相似的危险因素谱。然而，存在一些重要的差异关联，以及关联程度的实质性差异。这可能反映了不同血管床动脉粥样硬化形成的独特生物学特性。决定因素的差异突出表明，需要分别观察冠心病事件和缺血性卒中这两种心血管疾病的表现。
