Bruce Samuel S, Zhang Cenai, Liberman Ava L, Merkler Alexander E, Navi Babak B, Chiang Gloria C, Iadecola Costantino, Kamel Hooman, Murthy Santosh B
Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA.
Brain Health Imaging Institute and Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
Ann Neurol. 2025 Aug;98(2):249-257. doi: 10.1002/ana.27253. Epub 2025 May 1.
There are limited population-based data regarding the prevalence of cerebral amyloid angiopathy (CAA) and associated risks of mortality and incident cerebrovascular events.
We performed a retrospective cohort study using inpatient and outpatient claims from 2008 to 2022 from a 5% national sample of Medicare beneficiaries. CAA and ischemic and hemorrhagic stroke were identified using validated International Classification of Diseases 10th Revision (ICD-10) codes. We ascertained CAA from October 1, 2015 through 2022, and used data from 2008 through September 30, 2015 to ascertain comorbidities including prevalent stroke. We used Cox regression to examine the association of CAA with subsequent death and incident stroke subtypes after adjustment for demographics, vascular risk factors, and Charlson comorbidities.
Among 1,920,312 Medicare beneficiaries in our sample, 2,161 (11.3 per 10,000) had a diagnosis of CAA. In adjusted Cox regression analysis, there was an association between CAA and subsequent mortality (HR 4.9; 95% CI 4.6-5.2). Among 1,872,474 patients without prevalent stroke, including 900 of the CAA patients, there was a significant association between CAA and an increased risk of any stroke (HR 8.0; 95% CI 6.7-9.6), ischemic stroke (HR 4.6; 95% CI 3.6-6.0), intracerebral hemorrhage (HR 26.9; 95% CI 20.3-35.6), and subarachnoid hemorrhage (HR 21.6; 95% CI 12.2-38.1). After a diagnosis of CAA, absolute risks of ischemic stroke and intracerebral hemorrhage were broadly similar.
In a large, nationwide cohort of Medicare beneficiaries, the prevalence of clinically diagnosed CAA was approximately 11 per 10,000. CAA was associated with an increased risk of mortality and incident stroke, both hemorrhagic and ischemic. ANN NEUROL 2025;98:249-257.
关于脑淀粉样血管病（CAA）的患病率以及相关的死亡风险和脑血管事件发生率，基于人群的数据有限。
我们进行了一项回顾性队列研究，使用了2008年至2022年来自5%的医疗保险受益人的全国样本的住院和门诊理赔数据。使用经过验证的国际疾病分类第十版（ICD-10）编码来识别CAA以及缺血性和出血性中风。我们确定了2015年10月1日至2022年期间的CAA，并使用2008年至2015年9月30日的数据来确定包括既往中风在内的合并症。我们使用Cox回归来检验在调整人口统计学、血管危险因素和Charlson合并症后CAA与随后的死亡和中风亚型发生率之间的关联。
在我们样本中的1,920,312名医疗保险受益人中，2,161人（每10,000人中有11.3人）被诊断为CAA。在调整后的Cox回归分析中，CAA与随后的死亡率之间存在关联（风险比4.9；95%置信区间4.6 - 5.2）。在1,872,474名无既往中风的患者中，包括900名CAA患者，CAA与任何中风风险增加（风险比8.0；95%置信区间6.7 - 9.6）、缺血性中风（风险比4.6；95%置信区间3.6 - 6.0）、脑出血（风险比26.9；95%置信区间20.3 - 35.6）和蛛网膜下腔出血（风险比21.6；95%置信区间12.2 - 38.1）之间存在显著关联。在诊断为CAA后，缺血性中风和脑出血的绝对风险大致相似。
在一个大型的全国性医疗保险受益人队列中，临床诊断的CAA患病率约为每10,000人中有11人。CAA与死亡风险以及出血性和缺血性中风的发生率增加有关。《神经病学年鉴》2025年；98:249 - 257。
