Robinson Keira, Katzenellenbogen Judith M, Kleinig Timothy J, Kim Joosup, Budgeon Charley A, Thrift Amanda G, Nedkoff Lee
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Clin Epidemiol. 2023 Feb 18;15:203-211. doi: 10.2147/CLEP.S390146. eCollection 2023.
People with cardiac disease have 2-4 times greater risk of stroke than the general population. We measured stroke incidence in people with coronary heart disease (CHD), atrial fibrillation (AF) or valvular heart disease (VHD).
We used a person-linked hospitalization/mortality dataset to identify all people hospitalized with CHD, AF or VHD (1985-2017), and stratified them as pre-existing (hospitalized 1985-2012 and alive at October 31, 2012) or new (first-ever cardiac hospitalization in the five-year study period, 2012-2017). We identified first-ever strokes occurring from 2012 to 2017 in patients aged 20-94 years and calculated age-specific and age-standardized rates (ASR) for each cardiac cohort.
Of the 175,560 people in the cohort, most had CHD (69.9%); 16.3% had multiple cardiac conditions. From 2012-17, 5871 first-ever strokes occurred. ASRs were greater in females than males in single and multiple condition cardiac groups, largely driven by rates in females aged ≥75 years, with stroke incidence in this age group being at least 20% greater in females than males in each cardiac subgroup. In females aged 20-54 years, stroke incidence was 4.9-fold greater in those with multiple versus single cardiac conditions. This differential declined with increasing age. Non-fatal stroke incidence was greater than fatal stroke in all age groups except in the 85-94 age group. Incidence rate ratios were up to 2-fold larger in new versus pre-existing cardiac disease.
Stroke incidence in people with cardiac disease is substantial, with older females, and younger patients with multiple cardiac conditions, at elevated risk. These patients should be specifically targeted for evidence-based management to minimize the burden of stroke.
患有心脏病的人群发生中风的风险是普通人群的2至4倍。我们对冠心病（CHD）、心房颤动（AF）或心脏瓣膜病（VHD）患者的中风发病率进行了测量。
我们使用了一个与个人相关的住院/死亡率数据集来识别所有因CHD、AF或VHD住院的患者（1985 - 2017年），并将他们分为既往存在（1985 - 2012年住院且在2012年10月31日仍存活）或新发（在五年研究期内首次因心脏病住院，2012 - 2017年）两类。我们确定了2012年至2017年期间年龄在20 - 94岁的患者中首次发生的中风，并计算了每个心脏病队列的年龄特异性和年龄标准化率（ASR）。
在该队列的175,560人中，大多数患有CHD（69.9%）；16.3%患有多种心脏病。2012 - 2017年期间，共发生5871例首次中风。在单一和多种心脏病患者组中，女性的ASR高于男性，这在很大程度上是由75岁及以上女性的发病率驱动的，在每个心脏病亚组中，该年龄组女性的中风发病率比男性至少高20%。在20 - 54岁的女性中，患有多种心脏病者的中风发病率是患有单一心脏病者的4.9倍。这种差异随着年龄的增长而减小。除85 - 94岁年龄组外，所有年龄组的非致命性中风发病率均高于致命性中风。新发心脏病患者的发病率比与既往存在心脏病患者相比高达2倍。
心脏病患者的中风发病率很高，老年女性以及患有多种心脏病的年轻患者风险更高。这些患者应成为基于证据管理的特定目标人群，以尽量减轻中风负担。
