Rezk Amal, Liu Winnie, Nijs Kristof, Lee Jun Won, Rajaleelan Wesley, Nakatani Rodrigo, Al Azazi Emad, Englesakis Marina, Chowdhury Tumul
Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
J Neurosurg Anesthesiol. 2025 Apr 1;37(2):156-165. doi: 10.1097/ANA.0000000000000987. Epub 2024 Aug 22.
Neurological and cardiovascular disorders are the leading causes of morbidity and mortality worldwide. While the effects of cardiovascular disease (CD) on the nervous system are well understood, understanding of the reciprocal relationship has only recently become clearer. Based on disability-adjusted life years, this systematic review and meta-analysis present the pooled incidence and association of CD in 4 selected common, noncommunicable neurological disorders: (1) migraine, (2) Alzheimer disease and other dementias, (3) epilepsy, and (4) head injury. Sixty-five studies, including over 4 and a half million patients, were identified for inclusion in this review. Among the 4 neurological disorders, the majority of patients (89.4%) had epilepsy, 9.6% had migraine, and 0.97% had head injury. Alzheimer disease and other dementias were reported in only 0.02% of patients. The pooled effect estimates (incidence and association) of CD in the 4 neurological disorders was 10% (95% CI: 5.8%-16.9%; I2 = 99.94%). When stratified by the neurological disorder, head injury was associated with the highest incidence of CD (28%). The 4 neurological disorders were associated with a 2-fold increased odds for developing CD in comparison to patients without neurological disorders. Epilepsy was associated with the greatest increased odds of developing CD (odds ratio: 2.25; 95% CI: 1.82-2.79; P = 0.04). In studies that reported this variable, the pooled hazard ratio was 1.64 (95% CI: 1.38-1.94), with head injury having the highest hazard ratio (2.17; 95% CI: 1.30-3.61). Large prospective database studies are required to understand the long-term consequences of CD in patients with neurological disorders.
神经和心血管疾病是全球发病和死亡的主要原因。虽然心血管疾病（CD）对神经系统的影响已得到充分了解，但对这种相互关系的认识直到最近才变得更加清晰。基于伤残调整生命年，本系统评价和荟萃分析呈现了4种常见非传染性神经系统疾病中CD的合并发病率及相关性：（1）偏头痛，（2）阿尔茨海默病和其他痴呆症，（3）癫痫，以及（4）头部损伤。本评价纳入了65项研究，包括超过450万名患者。在这4种神经系统疾病中，大多数患者（89.4%）患有癫痫，9.6%患有偏头痛，0.97%患有头部损伤。仅0.02%的患者报告患有阿尔茨海默病和其他痴呆症。4种神经系统疾病中CD的合并效应估计值（发病率和相关性）为10%（95%置信区间：5.8%-16.9%；I² = 99.94%）。按神经系统疾病分层时，头部损伤与CD的最高发病率相关（28%）。与无神经系统疾病的患者相比，这4种神经系统疾病使发生CD的几率增加了2倍。癫痫与发生CD的几率增加最大相关（优势比：2.25；95%置信区间：1.82-2.79；P = 0.04）。在报告了该变量的研究中，合并风险比为1.64（95%置信区间：1.38-1.94），头部损伤的风险比最高（2.17；95%置信区间：1.30-3.61）。需要开展大型前瞻性数据库研究来了解神经系统疾病患者中CD的长期后果。
