Nawaz Beenish, Fromm Annette, Øygarden Halvor, Eide Geir Egil, Saeed Sahrai, Meijer Rudy, Bots Michiel L, Sand Kristin Modalsli, Thomassen Lars, Næss Halvor, Waje-Andreassen Ulrike
Department of Clinical Medicine 1, University of Bergen, Bergen, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Eur Stroke J. 2022 Sep;7(3):289-298. doi: 10.1177/23969873221098582. Epub 2022 May 10.
We studied the prevalence of vascular risk factors (RFs) among 385 ischaemic stroke patients ⩽60 years and 260 controls, and their association with atherosclerosis in seven vascular areas.
History of cardiovascular events (CVE), hypertension, diabetes mellitus (DM), dyslipidaemia, pack-years of smoking (PYS), alcohol, and physical inactivity were noted. Blood pressure, body mass index (BMI), waist-hip ratio (WHR), lipid profile, epicardial adipose tissue (EAT), visceral abdominal adipose tissue (VAT), and subcutaneous abdominal adipose tissue were measured. Numeric staging of atherosclerosis was done by standardized examination of seven vascular areas by right and left carotid and femoral intima-media thickness, electrocardiogram, abdominal aorta plaques, and the ankle-arm index. All results were age and sex-adjusted. Poisson regression analysis was applied.
At age ⩽49 years at least one RF was present in 95.6% patients versus 90.0% controls. Compared to controls, male patients and middle-aged female patients showed no significant differences. Young female patients compared to young female controls had a higher burden of RFs (94.3% vs 88.6%, = 0.049). Poisson regression analysis combined for patients and controls, adjusted for age and sex, showed numeric staging of atherosclerosis associated with age, prior CVE, hypertension, DM, dyslipidaemia, PYS, alcohol, BMI, WHR, EAT, VAT, and an increased number of risk factors. Adjusted for all risk factors, numeric staging of atherosclerosis was associated with increasing age, hypertension, DM, PYS, and BMI.
Vascular risk factors are highly prevalent in young- and middle-aged patients and controls, and are predictors of established atherosclerosis at study inclusion. Focus on main modifiable vascular RFs in primary prevention, and early and aggressive secondary treatment of patients are necessary to reduce further progression of atherosclerosis.
我们研究了385例60岁及以下缺血性脑卒中患者和260例对照者中血管危险因素（RFs）的患病率，以及它们与七个血管区域动脉粥样硬化的关联。
记录心血管事件（CVE）史、高血压、糖尿病（DM）、血脂异常、吸烟包年数（PYS）、饮酒情况和身体活动不足情况。测量血压、体重指数（BMI）、腰臀比（WHR）、血脂谱、心外膜脂肪组织（EAT）、腹部内脏脂肪组织（VAT）和腹部皮下脂肪组织。通过对左右颈动脉和股动脉内膜中层厚度、心电图、腹主动脉斑块和踝臂指数对七个血管区域进行标准化检查，对动脉粥样硬化进行数字分期。所有结果均进行了年龄和性别校正。应用泊松回归分析。
在49岁及以下年龄组，95.6%的患者至少存在一种RF，而对照组为90.0%。与对照组相比，男性患者和中年女性患者无显著差异。年轻女性患者与年轻女性对照组相比，RF负担更高（94.3%对88.6%，P = 0.049）。对患者和对照组进行年龄和性别校正后的泊松回归分析显示，动脉粥样硬化的数字分期与年龄、既往CVE、高血压、DM、血脂异常、PYS、饮酒、BMI、WHR、EAT、VAT以及危险因素数量增加有关。在对所有危险因素进行校正后，动脉粥样硬化的数字分期与年龄增加、高血压、DM、PYS和BMI有关。
血管危险因素在年轻和中年患者及对照者中高度流行，并且在研究纳入时是已确立动脉粥样硬化的预测因素。在一级预防中关注主要可改变的血管RFs，对患者进行早期积极的二级治疗对于减少动脉粥样硬化的进一步进展是必要的。
