血管风险因素对脑淀粉样血管病的影响：对遗传性脑淀粉样血管病的队列研究和对散发性脑淀粉样血管病的系统回顾。

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-11-18 DOI:10.1159/000542666

Sabine Voigt, Ingeborg Rasing, Maaike C van der Plas, Sarah J H Khidir, Emma A Koemans, Kanishk Kaushik, Ellis S van Etten, Jan W Schoones, Erik W van Zwet, Marieke J H Wermer

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引用次数: 0

摘要

背景：脑淀粉样血管病（CAA）的病程变化很大，即使是单基因遗传型也不例外。我们的目的是调查荷兰型遗传性（D-）CAA和散发性CAA中血管风险因素的流行情况及其对发病和病程的影响：我们对D-CAA进行了一项队列研究，通过生存分析研究血管危险因素（高血压、高胆固醇血症、吸烟和酗酒）与脑内出血（ICH）发病年龄和ICH复发时间之间的关系。此外，我们还进行了一项系统性综述，以评估散发性 CAA 中血管风险因素的发生率及其对临床结果的影响。我们检索了1987-2022年间的PubMed、Embase、Web of Science和COCHRANE图书馆，纳入了≥10名患者的队列。我们绘制了森林图，计算了汇总估计值，并报告了变异性（异质性加抽样变异性）和偏倚风险：我们纳入了 70 名 D-CAA 患者（47% 为女性，平均年龄 53 岁）。16人（23%）患有高血压，15人（21%）患有高胆固醇血症，45人（64%）吸烟，61人（87%）酗酒。我们发现血管风险因素对首次 ICH 的年龄没有明显影响（对数秩检验高血压：P=0.35；高胆固醇血症：P=0.41；吸烟：P=0.61；饮酒：P=0.55），对 ICH 复发前的时间也没有影响（对数秩检验高血压：P=0.71；高胆固醇血症：P=0.20；吸烟：P=0.71）。在筛选出的 1234 篇论文中，我们发现 25 篇评估了 CAA 中风险因素的流行率，6 篇报告了临床结果。高血压、糖尿病、血脂异常和吸烟的总体患病率估计分别为 62% (95%CI:55%-69%)、17% (95%CI:14%-20%)、32% (95%CI:23%-41%)和 27% (95%CI:18%-36%)。一项研究报告称，糖尿病和高血压与降低复发性 ICH 风险有关，而另一项研究报告称高血压与增加风险有关。所有其他研究均显示血管风险因素与临床结果无关。目前还缺乏以血管风险因素为重点的高质量研究：结论：在D-CAA和散发性CAA患者中，血管风险因素的发生率很高。结论：在 D-CAA 和散发性 CAA 患者中，血管风险因素的发生率很高，虽然这为预防提供了机会，但这些风险因素与 CAA 相关 ICH 的发生和复发之间没有明确的联系。

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THE IMPACT OF VASCULAR RISK FACTORS ON CEREBRAL AMYLOID ANGIOPATHY: A COHORT STUDY IN HEREDITARY CAA AND A SYSTEMATIC REVIEW IN SPORADIC CAA.

Background: Cerebral amyloid angiopathy (CAA) has a remarkably variable disease course, even in monogenetic hereditary forms. Our aim was to investigate the prevalence of vascular risk factors and their effect on disease onset and course in Dutch-type hereditary (D-)CAA and sporadic CAA.

Methods: We performed a cohort study in D-CAA to investigate the association between vascular risk factors (hypertension, hypercholesterolemia, smoking and alcohol use) and age of intracerebral hemorrhage (ICH) onset and time of ICH recurrence with survival analyses. In addition, we performed a systematic review to assess the prevalence of vascular risk factors and their effect on clinical outcome in sporadic CAA. We searched PubMed, Embase, Web of Science and COCHRANE Library, from 1987-2022 and included cohorts with ≥10 patients. We created forest plots, calculated pooled estimates and reported variability (heterogeneity plus sampling variability) and risk of bias.

Results: We included 70 participants with D-CAA (47% women, mean age 53y). Sixteen (23%) had hypertension, 15 (21%) hypercholesterolemia, 45 (64%) were smokers and 61 (87%) used alcohol. We found no clear effect of vascular risk factors on age of first ICH (log-rank test hypertension: p=0.35, hypercholesterolemia: p=0.41, smoking: p=0.61 and alcohol use: p=0.55) or time until ICH recurrence (log-rank test hypertension: p=0.71, hypercholesterolemia: p=0.20 and smoking: p=0.71). We identified 25 out of 1234 screened papers that assessed the prevalence of risk factors in CAA and 6 that reported clinical outcomes. The pooled prevalence estimates of hypertension was 62% (95%CI:55%-69%), diabetes 17% (95%CI:14%-20%), dyslipidemia 32% (95%CI:23%-41%), and tobacco use 27% (95%CI:18%-36%). One study reported study diabetes and hypertension to be associated with a lower risk of recurrent ICH, whereas another study reported hypertension to be associated with an increased risk. All other studies showed no association between vascular risk factors and clinical outcome. High quality studies focusing on vascular risk factors were lacking.

Conclusions: In patients with D-CAA and sporadic CAA the prevalence of vascular risk factors is high. Although this suggests an opportunity for prevention, there is no clear association between these risk factors and CAA-related ICH onset and recurrence.

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.