Department of Neurology, University of Colorado School of Medicine, Aurora.
Department of Neurology, University of California, San Francisco.
JAMA Neurol. 2022 Sep 1;79(9):901-910. doi: 10.1001/jamaneurol.2022.2077.
Arterial ischemic stroke (AIS) incidence has decreased overall in recent decades yet has increased in young adults. The potential associations with atherosclerotic risk factors (ARFs) remain unknown.
To assess the ages at which ARFs may be risk factors associated with AIS.
DESIGN, SETTING, AND PARTICIPANTS: A nested case-control study was conducted within Kaiser Permanente Northern California (KPNC) from January 1, 2000, through December 31, 2014. Data were analyzed from 2019 to 2022. Cases were identified using diagnostic codes and radiology reports. A total of 2 to 3 controls per case, matched on age and enrollment dates, were randomly identified and confirmed as stroke-free by medical record review. Only ARFs documented prior to stroke diagnosis (or the same date in controls) were considered to ensure the same period of observation. Comparisons were stratified by decade of life. Cases and controls were selected from the KPNC population (4.7 million children and 7.5 million young adults). Medical record review was conducted of all children (aged 29 days to 19 years) and a sample of young adults (aged 20-49 years) with International Classification of Diseases, Ninth Revision code or radiology text string search suggestive of AIS. Stroke-free controls were randomly selected.
Hypertension, hyperlipidemia, diabetes, obesity, and smoking history.
Odds of AIS. In all analyses, cases and controls were compared using logistic regression.
A total of 141 pediatric cases (69 [48.9%] aged 29 days to 9 years; 72 [51.1%] aged 10-19 years) and 364 pediatric controls (168 [46.2%] aged 0-9 years; 196 [53.8%] aged 10-19 years) and 455 young adult cases (71 [15.6%] aged 20-29 years; 144 [31.6%] aged 30-39 years; and 240 [52.7%] aged 40-49 years) and 1018 young adult controls (121 [11.9%] aged 20-29 years; 298 [29.3%] aged 30-39 years; and 599 [58.8%] aged 40-49 years) were identified. The percent of the cases that were male or female did not differ from the percent in the control group. The odds ratio (OR) of having any ARFs on AIS was 1.87 (95% CI, 0.72-4.88) for age range 0 to 9 years; OR, 1.00 (95% CI, 0.51-1.99) for age range 10 to 19 years; OR, 2.3 (95% CI, 1.17- 4.51) for age range 20 to 29 years; OR, 3.57 (95% CI, 2.34-5.45) for age range 30 to 39 years; and OR, 4.91 (95% CI, 3.52-6.86) for age range 40 to 49 years. The risk associated with multiple ARFs was OR, 5.29 (95% CI, 0.47-59.4) for age range 0 to 9 years; OR, 2.75 (95% CI, 0.77-9.87) for age range 10 to 19 years; OR, 7.33 (95% CI, 1.92-27.9) for age range 20 to 29 years; OR, 9.86 (95% CI, 4.96-19.6) for age range 30 to 39 years; and OR, 9.35 (95% CI, 6.31-13.8) for age range 40 to 49 years. The ARF findings by both definitions were significant in all young adult groups. Atherosclerosis was the presumed etiology in 0% of cases in the age group 0 to 9 years, 1.4% in the age group 10 to 19 years, 8.5% in the age group 20 to 29 years, 21.5% in the age group 30 to 39 years, and 42.5% in the age group 40 to 49 years.
Although atherosclerosis may not be a common cause of AIS in children or in early young adulthood, findings of this study suggest that ARFs associated with stroke in older adults are present in childhood and increase with age. Efforts to reduce these risk factors should begin as early as possible.
重要性：尽管近几十年来整体上动脉缺血性脑卒中 (AIS) 的发病率有所下降，但在年轻人中却有所增加。其与动脉粥样硬化危险因素 (ARF) 的潜在关联尚不清楚。
目的：评估 ARF 何时可能成为与 AIS 相关的危险因素。
设计、地点和参与者：这是一项嵌套病例对照研究，于 2000 年 1 月 1 日至 2014 年 12 月 31 日在 Kaiser Permanente Northern California (KPNC) 进行。数据分析于 2019 年至 2022 年进行。通过诊断代码和放射学报告识别病例。每例病例匹配 2 至 3 名年龄和入组日期匹配的对照，通过病历回顾确认无卒中。仅记录在卒中诊断（或对照中相同日期）之前的 ARF，以确保观察期相同。按生活的十年进行分层比较。病例和对照均选自 KPNC 人群（0.29 天至 19 岁的儿童 470 万，20-49 岁的年轻成人 750 万）。对所有 0.29 天至 19 岁的儿童（29 天至 19 岁）和部分 20-49 岁的年轻成人（20-29 岁；49 岁）进行国际疾病分类，第九版代码或放射学文本字符串搜索以提示 AIS。随机选择无卒中的对照。
暴露因素：高血压、高血脂、糖尿病、肥胖和吸烟史。
主要结果和措施：AIS 的可能性。在所有分析中，病例和对照组均采用 logistic 回归进行比较。
结果：共纳入 141 例儿科病例（69 例[48.9%]年龄为 0.29 天至 9 岁；72 例[51.1%]年龄为 10-19 岁）和 364 例儿科对照（168 例[46.2%]年龄为 0-9 岁；196 例[53.8%]年龄为 10-19 岁）和 455 例年轻成人病例（71 例[15.6%]年龄为 20-29 岁；144 例[31.6%]年龄为 30-39 岁；240 例[52.7%]年龄为 40-49 岁）和 1018 例年轻成人对照（121 例[11.9%]年龄为 20-29 岁；298 例[29.3%]年龄为 30-39 岁；599 例[58.8%]年龄为 40-49 岁）。病例中男性或女性的比例与对照组无差异。年龄范围 0 至 9 岁的病例中任何 ARF 的比值比 (OR) 为 1.87（95%CI，0.72-4.88）；年龄范围 10 至 19 岁的 OR 为 1.00（95%CI，0.51-1.99）；年龄范围 20 至 29 岁的 OR 为 2.3（95%CI，1.17-4.51）；年龄范围 30 至 39 岁的 OR 为 3.57（95%CI，2.34-5.45）；年龄范围 40 至 49 岁的 OR 为 4.91（95%CI，3.52-6.86）。与多个 ARF 相关的风险 OR 为 0-9 岁年龄范围为 5.29（95%CI，0.47-59.4）；年龄范围 10-19 岁的 OR 为 2.75（95%CI，0.77-9.87）；年龄范围 20-29 岁的 OR 为 7.33（95%CI，1.92-27.9）；年龄范围 30-39 岁的 OR 为 9.86（95%CI，4.96-19.6）；年龄范围 40-49 岁的 OR 为 9.35（95%CI，6.31-13.8）。两种定义的 ARF 发现均在所有年轻成人组中具有统计学意义。0-9 岁年龄组中，动脉粥样硬化为病因的比例为 0%，10-19 岁年龄组为 1.4%，20-29 岁年龄组为 8.5%，30-39 岁年龄组为 21.5%，40-49 岁年龄组为 42.5%。
结论和相关性：尽管动脉粥样硬化可能不是儿童或年轻成年人早期卒中的常见病因，但本研究结果表明，与老年卒中相关的 ARF 存在于儿童时期，并随年龄增长而增加。应尽早开始努力减少这些危险因素。
