前国家橄榄球联盟运动员累积性脑震荡与中风几率。
Cumulative Concussion and Odds of Stroke in Former National Football League Players.
机构信息
Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa (B.L.B., M.A.M.).
Department of Exercise and Sport Science, University of North Carolina at Chapel Hill (Z.Y.K., A.C., S.W., J.D.D., K.M.G.).
出版信息
Stroke. 2022 Jan;53(1):e5-e8. doi: 10.1161/STROKEAHA.121.035607. Epub 2021 Nov 29.
BACKGROUND AND PURPOSE
Postmortem and experimental studies indicate a potential association between repeated concussions and stroke risk in older contact sport athletes. We examined the relationship between concussion and stroke history in former National Football League players aged ≥50 years.
METHODS
Former professional football players aged ≥50 years who played ≥1 year in the National Football League were enrolled in the cross-sectional study. Indirect standardization was used to calculate overall and decade-specific standardized prevalence ratios. Logistic regression using Firth's bias reduction method examined the association between lifetime concussion history 0 (n=119; 12.2%), 1 to 2 (n=152; 15.5%), 3 to 5 (n=242; 24.7%), 6 to 9 (201; 20.5%), and 10+(n=265; 27.1%) and stroke. Adjusted odds ratios for stroke were calculated for concussion history groups, age, and coronary artery disease and/or myocardial infarction.
RESULTS
The 979 participants who met inclusion criteria had a mean age of 65.0±9.0 years (range, 50-99). The prevalence of stroke was 3.4% (n=33), significantly lower than expected based on rates of stroke in US men aged 50 and over (standardized prevalence ratio=0.56, Z= -4.56, <0.001). Greater odds of stroke history were associated with concussion history (10+ versus 0, adjusted odds ratio [95% CI]=5.51 [1.61-28.95]), cardiovascular disease (adjusted odds ratio [95% CI]=2.24 [1.01-4.77]), and age (1-year-increase adjusted odds ratio [95% CI]=1.07 [1.02-1.11]).
CONCLUSIONS
The prevalence of stroke among former National Football League players aged ≥50 years was lower than the general population, with significantly increased risk among those with 10 or more prior concussions. Findings add to the evidence suggesting that traumatic brain injuries are associated with increased risk of stroke. Clinically, management of cardio- and cerebrovascular health may be pertinent to those with a history of multiple prior concussions.
背景与目的
尸检和实验研究表明，反复脑震荡与老年接触性运动运动员的中风风险之间存在潜在关联。我们研究了年龄≥50 岁的前国家橄榄球联盟球员的脑震荡与中风史之间的关系。
方法
本横断面研究纳入了年龄≥50 岁、在国家橄榄球联盟至少打满 1 年的前职业足球运动员。使用间接标准化计算总体和每十年的标准化流行率比值。使用 Firth 偏置减少法的逻辑回归分析了一生中脑震荡史为 0（n=119；12.2%）、1-2 次（n=152；15.5%）、3-5 次（n=242；24.7%）、6-9 次（n=201；20.5%）和 10 次及以上（n=265；27.1%）与中风的关系。计算了脑震荡史组、年龄、冠心病和/或心肌梗死的中风调整比值比。
结果
符合纳入标准的 979 名参与者平均年龄为 65.0±9.0 岁（范围，50-99 岁）。中风的患病率为 3.4%（n=33），明显低于美国 50 岁及以上男性的中风发病率（标准化流行率比=0.56，Z=-4.56，<0.001）。中风史的几率与脑震荡史相关（10+ vs. 0，调整比值比[95%置信区间]=5.51[1.61-28.95]）、心血管疾病（调整比值比[95%置信区间]=2.24[1.01-4.77]）和年龄（每年增加的调整比值比[95%置信区间]=1.07[1.02-1.11]）。
结论
年龄≥50 岁的前国家橄榄球联盟球员的中风患病率低于一般人群，有 10 次或更多既往脑震荡史的患者中风风险显著增加。研究结果进一步证明，创伤性脑损伤与中风风险增加有关。临床上，对于有多次既往脑震荡史的患者，管理心脑血管健康可能很重要。
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