Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
JAMA Netw Open. 2024 Nov 4;7(11):e2444534. doi: 10.1001/jamanetworkopen.2024.44534.
The association between nonarteritic anterior ischemic optic neuropathy (NAION) and an increased risk of stroke has been a subject of debate. However, multinational studies on this topic are scarce.
To evaluate the short-term and long-term stroke risk after NAION compared with a matched control group.
DESIGN, SETTING, AND PARTICIPANTS: This global, retrospective, population-based cohort study used aggregated electronic health records from January 1, 2004, through March 19, 2024, sourced from the Global Collaborative Network of TriNetX, which includes data from over 152 million patients across 17 countries. Patients in the study were followed up for a maximum duration of 10 years. Patients with NAION and age-related cataract were included in the analysis. Those with stroke before the diagnosis of NAION and age-related cataract were excluded. Propensity score matching was applied to balance age, sex, race, ethnicity, comorbidities, and medication use.
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis code for NAION or age-related cataract.
The primary outcome was the relative risk (RR) of stroke (ICD-10 code I60-63) in the NAION cohort vs the matched controls. Multivariable logistic regression analyses were applied to identify potential clinical factors associated with stroke within the NAION cohort.
A total of 89 811 patients were identified in both the NAION (mean [SD] age, 57.2 [18.5] years; 38 678 men [43.1%]) and control (mean [SD] age, 57.0 [17.9] years; 40 014 men [44.6%]) cohorts after matching. The NAION cohort demonstrated a significantly higher all-stroke risk at all time points: 1 month (RR, 5.04; 95% CI, 4.41-5.78), 3 months (RR, 3.79; 95% CI, 3.40-4.21), 1 year (RR, 2.50; 95% CI, 2.32-2.70), 5 years (RR, 1.54; 95% CI, 1.45-1.63), and 10 years (RR, 1.33; 95% CI, 1.23-1.43). Sensitivity analysis in patients without comorbidities similarly revealed a significantly increased all-stroke risk across all intervals: 1 month (RR, 7.55; 95% CI, 4.74-12.03), 3 months (RR, 6.70; 95% CI, 4.48-10.04), 1 year (RR, 3.96; 95% CI, 2.94-5.34), 5 years (RR, 2.85; 95% CI, 2.18-3.72), and 10 years (RR, 1.68; 95% CI, 1.25-2.26). Among all the clinical factors of interest, only hypertension was consistently associated with all subtypes of stroke following NAION.
This cohort study of patients with NAION found a significantly elevated risk of stroke compared with matched controls, independently of comorbidities. These findings underscore the importance of regular stroke workups following the onset of NAION.
非动脉炎性前部缺血性视神经病变 (NAION) 与中风风险增加之间的关联一直存在争议。然而，关于这个主题的多国研究很少。
评估与匹配对照组相比，NAION 后短期和长期的中风风险。
设计、设置和参与者：这是一项全球性、回顾性、基于人群的队列研究，使用了来自全球协作网络 TriNetX 的聚合电子健康记录，该网络包含来自 17 个国家的超过 1.52 亿名患者的数据，时间范围为 2004 年 1 月 1 日至 2024 年 3 月 19 日。患者的随访时间最长可达 10 年。分析中包括患有 NAION 和年龄相关性白内障的患者。排除了在诊断为 NAION 和年龄相关性白内障之前患有中风的患者。应用倾向评分匹配来平衡年龄、性别、种族、民族、合并症和药物使用情况。
国际疾病分类第十版 (ICD-10) 诊断代码用于 NAION 或年龄相关性白内障。
主要结局是 NAION 队列与匹配对照组相比的中风相对风险 (RR)（ICD-10 代码 I60-63）。多变量逻辑回归分析用于识别 NAION 队列中与中风相关的潜在临床因素。
在匹配后，在 NAION（平均 [SD] 年龄，57.2 [18.5] 岁；38678 名男性 [43.1%]）和对照组（平均 [SD] 年龄，57.0 [17.9] 岁；40014 名男性 [44.6%]）中均确定了 89811 名患者。NAION 队列在所有时间点均显示出明显更高的全因中风风险：1 个月（RR，5.04；95%CI，4.41-5.78）、3 个月（RR，3.79；95%CI，3.40-4.21）、1 年（RR，2.50；95%CI，2.32-2.70）、5 年（RR，1.54；95%CI，1.45-1.63）和 10 年（RR，1.33；95%CI，1.23-1.43）。在无合并症的患者中进行的敏感性分析同样显示，所有间隔的全因中风风险显著增加：1 个月（RR，7.55；95%CI，4.74-12.03）、3 个月（RR，6.70；95%CI，4.48-10.04）、1 年（RR，3.96；95%CI，2.94-5.34）、5 年（RR，2.85；95%CI，2.18-3.72）和 10 年（RR，1.68；95%CI，1.25-2.26）。在所有感兴趣的临床因素中，只有高血压与 NAION 后所有类型的中风均存在相关性。
这项对 NAION 患者的队列研究发现，与匹配对照组相比，中风风险显著升高，且独立于合并症。这些发现强调了在 NAION 发病后定期进行中风检查的重要性。
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