Extracranial Vascular Malformations Increase Cardiovascular Disease Risk: A Nationwide Population-Based Cohort Study
Jeong Yeop Ryu1, Yong June Chang1, Joon Seok Lee1
1From the Departments of Plastic and Reconstructive Surgery.
Insights
Extracranial vascular malformations increase the risk of myocardial infarction (MI), ischemic stroke (IS), and hemorrhagic stroke (HS). Capillary malformations (CMs) and arteriovenous malformations (AVMs) are linked to particularly high risks of intracerebral hemorrhage.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Extracranial vascular malformations (EVMs) can influence inflammation, clotting, and ischemia.
- The association between EVMs and major cardiovascular events like myocardial infarction (MI) or stroke remains incompletely understood.
- Limited research exists on the link between EVMs and cardiovascular diseases.
Purpose of the Study:
- To investigate the association between EVMs and the risk of MI, ischemic stroke (IS), and hemorrhagic stroke (HS).
- To compare the incidence and risk of these cardiovascular events in patients with EVMs versus a control group.
Main Methods:
- A large cohort study utilizing the Korean National Health Insurance database.
- Inclusion of 48,701 patients diagnosed with EVMs and a control group of 487,010 age- and sex-matched participants.
- Comparison of the incidence and risk of MI, IS, and HS between the EVM cohort and the control cohort, adjusting for cardiovascular risk factors.
Main Results:
- EVMs were independently associated with an increased risk of MI, IS, and HS.
- Specific malformation types showed varying risk increases: venous malformations (MI: 1.25, IS: 1.55, HS: 1.51), capillary malformations (CMs) (MI: 1.41, IS: 1.92, HS: 5.63), arteriovenous malformations (AVMs) (MI: 1.68, IS: 1.13, HS: 2.93), and lymphatic malformations (MI: 1.40, IS: 1.51, HS: 1.34).
- Patients with CMs and AVMs exhibited particularly high adjusted hazard ratios for HS (5.63 and 2.93, respectively).
Conclusions:
- Extracranial vascular malformations are an independent risk factor for MI, IS, and HS.
- The risk of intracerebral hemorrhage is significantly elevated in patients with CMs and AVMs.
- Diagnostic evaluation for cerebral AVMs and preventive measures for intracerebral hemorrhage are crucial for patients with extracranial CMs or AVMs.
Background:
Extracranial vascular malformations affect vessel inflammation, clotting, and ischemia. However, the relationship between extracranial vascular malformations and myocardial infarction (MI) or stroke has not been fully elucidated. Limited studies have investigated the association between extracranial vascular malformations and cardiovascular diseases.
Methods:
A total of 48,701 patients with extracranial vascular malformations and a control cohort of 487,010 age- and sex-matched participants from the Korean National Health Insurance database were included. The incidence and risk of MI, ischemic stroke (IS), and hemorrhagic stroke (HS) between participants with extracranial vascular malformations and the control cohort was compared.
Results:
After adjusting for other cardiovascular disease risk factors, the adjusted hazard ratios (aHRs) for venous malformations, capillary malformations (CMs), arteriovenous malformations (AVMs), and lymphatic malformations in patients with acute MI were 1.25 (CI, 1.04 to 1.50), 1.41 (CI, 1.24 to 1.61), 1.68 (CI, 1.18 to 2.37), and 1.40 (CI, 1.31 to 1.48), respectively. For IS, the aHRs were 1.55 (CI, 1.35 to 1.77), 1.92 (CI, 1.74 to 2.11), 1.13 (CI, 0.78 to 1.64), and 1.51 (CI, 1.44 to 1.58), respectively. For HS, the aHRs were 1.51 (CI, 1.12 to 2.05), 5.63 (CI, 4.97 to 6.38), 2.93 (CI, 1.82 to 4.72), and 1.34 (CI, 1.20 to 1.50), respectively.
Conclusions:
Independent of cardiovascular risk factors, extracranial vascular malformations were associated with an increased risk of MI, IS, and HS. For patients with CMs and AVMs, intracerebral hemorrhage risk was particularly high, accounting for 563% and 293%, respectively. Therefore, even in patients with extracranial CMs or AVMs, performing diagnostic evaluations for cerebral AVMs and using measures to prevent intracerebral hemorrhage are crucial.
Clinical Question/Level Of Evidence:
Risk, II.
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