Kahan Joshua, Zhang Cenai, Liberman Ava L, Segal Alan Z, Murthy Santosh B, Kim Jiwon, Kamel Hooman, Merkler Alexander E
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Division of Cardiology, Weill Cornell Medicine, New York, New York, USA.
Ann Clin Transl Neurol. 2024 Dec;11(12):3095-3102. doi: 10.1002/acn3.52216. Epub 2024 Oct 23.
Many cases of cervical artery dissection are considered "spontaneous." Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection.
We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time-dependent confounding.
Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40-2.41]), alcohol use (HR 1.83 [1.52-2.21]), atrial fibrillation (HR 1.80 [1.53-2.11]), tobacco use (HR 1.80 [1.52-2.13]), coronary artery disease (HR 1.56 [1.33-1.82]), and valvular heart disease (HR 1.23 [1.05-1.45]).
In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted.
许多颈动脉瘤夹层病例被认为是“自发性的”。近期数据表明，虽然颈动脉瘤夹层在年轻患者中导致的中风比例可能更高，但因夹层而住院的情况却随年龄增加，这表明后天性血管疾病可能起到了一定作用。在本研究中，我们假设传统血管危险因素和合并症与颈动脉瘤夹层有关。
我们利用来自5%医疗保险受益人的行政索赔数据进行了一项回顾性队列研究。感兴趣的暴露因素包括传统血管危险因素和合并症：冠状动脉疾病、高脂血症、高血压、糖尿病、心力衰竭、慢性肾病、慢性阻塞性肺疾病、心脏瓣膜病、心房颤动、吸烟和酗酒。主要结局是颈动脉瘤夹层的新诊断。采用边际结构Cox模型来描述暴露因素与结局之间的关联，并对随时间变化的混杂因素进行了调整。
在2256710名符合条件的医疗保险受益人中，730人（0.03%）发生了颈动脉瘤夹层。发现以下暴露因素与颈动脉瘤夹层的发生显著相关：高血压（风险比1.84 [95%置信区间：1.40 - 2.41]）、饮酒（风险比1.83 [1.52 - 2.21]）、心房颤动（风险比1.80 [1.53 - 2.11]）、吸烟（风险比1.80 [1.52 - 2.13]）、冠状动脉疾病（风险比1.56 [1.33 - 1.82]）和心脏瓣膜病（风险比1.23 [1.05 - 1.45]）。
在一大群老年人中，几种传统血管危险因素和合并症与随后发生的颈动脉瘤夹层有关。有必要进一步研究这些因素在颈动脉瘤夹层发生过程中的作用。
