Chamberlin Keran W, Li Chenxi, Kucharska-Newton Anna, Luo Zhehui, Reeves Mathew, Shrestha Srishti, Pinto Jayant M, Deal Jennifer A, Kamath Vidyulata, Palta Priya, Couper David, Mosley Thomas H, Chen Honglei
Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (K.W.C., C.L., Z.L., M.R., H.C.).
Department of Epidemiology, Gillings School of Global Public Health (A.K.-N.), University of North Carolina at Chapel Hill.
Stroke. 2025 Feb;56(2):465-474. doi: 10.1161/STROKEAHA.124.048713. Epub 2025 Jan 27.
Poor olfaction may be associated with adverse cerebrovascular events, but empirical evidence is limited. We aimed to investigate the association of olfaction with the risk of stroke in the Atherosclerosis Risk in Communities Study.
We included 5799 older adults with no history of stroke at baseline from 2011 to 2013 (75.5±5.1 years, 59.0% female and 22.2% Black). Olfaction was assessed by the 12-item Sniffin' Sticks odor identification test and defined as poor (number correct ≤8), moderate (9-10), or good (11-12). Participants were followed from baseline to the date of the first stroke, death, last contact, or December 31, 2020, whichever occurred first. We used the discrete-time subdistribution hazard model to estimate the marginal cumulative incidence of stroke across olfactory statuses and adjusted risk ratios, accounting for covariates and competing risk of death.
After up to 9.6 years of follow-up, we identified 332 incident stroke events. The adjusted marginal cumulative incidence of stroke at 9.6-year follow-up was 5.3% (95% CI, 4.2%-6.3%), 5.9% (95% CI, 4.8%-7.1%), and 7.7% (95% CI, 6.5%-9.1%) for good, moderate, and poor olfaction, respectively. Compared with good olfaction, poor olfaction was significantly associated with higher stroke risk throughout follow-up, albeit the association modestly attenuated after 6 years. Specifically, the adjusted risk ratios were 2.14 (95% CI, 1.22-3.94) at year 2, 1.98 (95% CI, 1.43-3.02) at year 4, 1.91 (95% CI, 1.43-2.77) at year 6, 1.49 (95% CI, 1.17-2.00) at year 8, and 1.45 (95% CI, 1.16-1.95) at year 9.6. Results were robust in multiple subgroup and sensitivity analyses.
In older adults, poor olfaction assessed by a single olfaction test was associated with the higher risk of stroke in the next 10 years.
嗅觉减退可能与不良脑血管事件相关，但实证证据有限。我们旨在通过社区动脉粥样硬化风险研究调查嗅觉与中风风险之间的关联。
我们纳入了2011年至2013年基线时无中风病史的5799名老年人（75.5±5.1岁，女性占59.0%，黑人占22.2%）。通过12项嗅觉棒气味识别测试评估嗅觉，并将其定义为差（正确识别数量≤8）、中等（9 - 10）或良好（11 - 12）。从基线开始对参与者进行随访，直至首次中风、死亡、最后一次接触或2020年12月31日，以先发生者为准。我们使用离散时间子分布风险模型来估计不同嗅觉状态下中风的边际累积发病率和调整后的风险比，并考虑协变量和死亡的竞争风险。
经过长达9.6年的随访，我们确定了332例中风事件。在9.6年随访时，嗅觉良好、中等和较差者中风的调整后边际累积发病率分别为5.3%（95%CI，4.2% - 6.3%）、5.9%（95%CI，4.8% - 7.1%）和7.7%（95%CI，6.5% - 9.1%）。与嗅觉良好相比，嗅觉较差在整个随访期间与较高的中风风险显著相关，尽管这种关联在6年后略有减弱。具体而言，调整后的风险比在第2年为2.14（95%CI，1.22 - 3.94），第4年为1.98（95%CI，1.43 - 3.02），第6年为1.91（95%CI，1.43 - 2.77），第8年为1.49（95%CI，1.17 - 2.00），第9.6年为1.45（95%CI，1.16 - 1.95）。在多个亚组和敏感性分析中结果均稳健。
在老年人中，通过单一嗅觉测试评估的嗅觉减退与未来10年中风风险较高相关。
