Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults
Stéphanie Debette1, Tiina Metso, Alessandro Pezzini
1Department of Epidemiology and Public Health, Inserm U744, Institut Pasteur de Lille, 1, Rue du Professeur Calmette, BP245, 59019 Lille Cedex, France. stephdebette@wanadoo.fr
Insights
Hypertension may be a risk factor for cervical artery dissection (CEAD), while hypercholesterolemia, obesity, and overweightness appear inversely associated. This study analyzed risk factors in CEAD patients versus other stroke types.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- Cervical artery dissection (CEAD) is a significant cause of ischemic stroke (IS) in young adults.
- Established IS risk factors like hypertension, diabetes, smoking, hypercholesterolemia, and obesity have poorly understood roles in CEAD.
- The study investigates the prevalence of these vascular risk factors in CEAD patients compared to controls and non-CEAD IS patients.
Purpose of the Study:
- To compare the prevalence of key vascular risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking, obesity/overweightness) in patients with CEAD.
- To contrast these prevalence rates against those in patients with non-CEAD ischemic stroke and healthy referents.
- To elucidate the specific associations between these risk factors and CEAD.
Main Methods:
- Utilized data from the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study.
- Included 690 CEAD patients, 556 non-CEAD IS patients, and 1170 referents.
- Employed multinomial logistic regression, adjusted for country, age, and gender, to compare risk factor prevalence.
Main Results:
- CEAD patients showed a lower prevalence of hypercholesterolemia (OR 0.55), obesity (OR 0.37), and overweightness (OR 0.70) compared to referents.
- CEAD patients had a higher prevalence of hypertension (OR 1.67) than referents.
- All investigated vascular risk factors were less frequent in CEAD patients compared to non-CEAD IS patients.
Conclusions:
- Hypertension may be a risk factor for CEAD, despite being less prevalent than in non-CEAD IS patients.
- Hypercholesterolemia, obesity, and overweightness appear to be inversely associated with CEAD.
- Findings stem from the largest series to date, offering significant insights into CEAD etiology.
Background:
Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study.
Methods And Results:
The study sample comprised 690 CEAD patients (mean age, 44.2 ± 9.9 years; 43.9% women), 556 patients with a non-CEAD IS (44.7 ± 10.5 years; 39.9% women), and 1170 referents (45.9 ± 8.1 years; 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index ≥ 30 kg/m²) or overweightness (body mass index ≥ 25 kg/m² and <30 kg/m²) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55; 95% confidence interval, 0.42 to 0.71; P<0.0001), obesity (odds ratio 0.37; 95% confidence interval, 0.26 to 0.52; P<0.0001), and overweightness (odds ratio 0.70; 95% confidence interval, 0.57 to 0.88; P=0.002) but were more frequently hypertensive (odds ratio 1.67; 95% confidence interval, 1.32 to 2.1; P<0.0001). All vascular risk factors were less frequent in CEAD patients compared with young patients with a non-CEAD IS. The latter were more frequently hypertensive, diabetic, and current smokers compared with referents.
Conclusion:
These results, from the largest series to date, suggest that hypertension, although less prevalent than in patients with a non-CEAD IS, could be a risk factor of CEAD, whereas hypercholesterolemia, obesity, and overweightness are inversely associated with CEAD.
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