Chronic Obstructive Pulmonary Disease and the Risk of Stroke The Rotterdam Study

被引:104
作者
Portegies, Marileen L. P. [1 ,2 ]
Lahousse, Lies [1 ,6 ]
Joos, Guy F. [6 ]
Hofman, Albert [1 ]
Koudstaal, Peter J. [2 ]
Stricker, Bruno H. [1 ,3 ]
Brusselle, Guy G. [1 ,4 ,6 ]
Ikram, M. Arfan [1 ,2 ,5 ]
机构
[1] Erasmus MC Univ Med Ctr, Dept Epidemiol, POB 2040, NL-3000 CA Rotterdam, Netherlands
[2] Erasmus MC Univ Med Ctr, Dept Neurol, NL-3000 CA Rotterdam, Netherlands
[3] Erasmus MC Univ Med Ctr, Dept Internal Med, NL-3000 CA Rotterdam, Netherlands
[4] Erasmus MC Univ Med Ctr, Dept Resp Med, NL-3000 CA Rotterdam, Netherlands
[5] Erasmus MC Univ Med Ctr, Dept Radiol, NL-3000 CA Rotterdam, Netherlands
[6] Ghent Univ Hosp, Dept Resp Med, Ghent, Belgium
关键词
chronic airflow obstruction; exacerbations; cerebral infarction; intracerebral hemorrhage; epidemiology; CORONARY-HEART-DISEASE; CARDIOVASCULAR-DISEASE; MYOCARDIAL-INFARCTION; ISCHEMIC-STROKE; LIFETIME RISK; COPD; PREVALENCE; MORTALITY; ATHEROSCLEROSIS; CLASSIFICATION;
D O I
10.1164/rccm.201505-0962OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Worldwide,. chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD. Objectives: To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations. Methods: Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model. Measurements and Main Results: COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00-1.43), ischemic stroke (HR, 1.27; 1.02-1.59), and hemorrhagic stroke (HR, 1.70;1.01-2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91-1.31) for all stroke; HR, 1.13 (0.91-1.42) for ischemic stroke; and HR 1.53 (0.91-2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42-18.20) increased risk of stroke. Conclusions: Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
引用
收藏
页码:251 / 258
页数:8
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