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Stroke:卒中和痴呆的长期发病率

2021-07-02 MedSci原创 MedSci原创

与基于阿替洛尔的降压方案相比,基于氨氯地平的降压方案降低了卒中的长期发病率,但对痴呆症没有可显著的影响。阿托伐他汀对卒中或痴呆症均无效应。较高的血压变异性与较高的后期痴呆和卒中发生率相关。

卒中危险因素进行管理可能会减少后期痴呆症的发生。卒中危险因素的管理可能会减少后期的痴呆症。

近日,血管疾病领域权威杂志Stroke上发表了一篇研究文章,在ASCOT(盎格鲁-斯堪的纳维亚结局试验)中,研究人员旨在明确痴呆或卒中是否与不同的降压治疗方案(阿托伐他汀或安慰剂)和平均血压、血压变异性和平均胆固醇水平相关。


伴有3个以上心血管疾病危险因素的高血压参与者被随机分配接受基于氨氯地平或阿替洛尔降压方案的治疗,血压目标为BP<140/90mmHg,为期5.5年。总胆固醇≤6.5mmol/L的参与者也被随机分配至10mg 阿托伐他汀或安慰剂治疗,为期3.3年。从6个月到试验结束,研究人员计算了平均和LDL(低密度脂蛋白)胆固醇、BP和BP的SD。研究人员将英国参与者与电子健康记录中心相关联,以确定普通医院和精神健康医院的死亡和住院情况。研究人员通过经验证的代码列表确认痴呆症和卒中。

降压药物与卒中和痴呆发病率的关系

 
在8580名英国参与者中,有7300人在随机化分组后进行了长达21年的随访。与安慰剂相比,阿托伐他汀治疗3.3年对卒中(264 vs. 272;调整后的风险比[HR]为0.92[95%CI为0.78-1.09];P=0.341)或痴呆(238 vs. 227;调整后的HR为0.98[95]%CI为0.82–1.18];P=0.837)没有明显的效应。平均总胆固醇与后来的卒中或痴呆无关。与基于阿替洛尔的治疗方案相比,基于氨氯地平的治疗方案持续5.5年可减少卒中(443 vs. 522;调整后的HR为0.82[95%CI,0.72–0.93];P=0.003),但不会减少痴呆(450 vs. 465;调整后的HR为0.94[95%CI为0.82-1.07];P=0.334)。调整平均血压后,血压变异性(SD平均血压)与较高的痴呆(每5mmHg对应的HR为1.14[95%CI为1.06-1.24];P<0.001)和卒中(HR为1.21[95%CI为1.12-1.32];P<0.001)风险相关。
 
由此可见,与基于阿替洛尔的降压方案相比,基于氨氯地平的降压方案降低了卒中的长期发病率,但对痴呆症没有可显著的影响。阿托伐他汀对卒中或痴呆症均无效应。较高的血压变异性与较高的后期痴呆和卒中发生率相关。

原始出处:

William N. Whiteley.et al.Long-Term Incidence of Stroke and Dementia in ASCOT.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.033489

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1823728, encodeId=177c1823e28b0, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jan 20 17:07:49 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=995492, encodeId=3967995492b9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/4850b6a0bb884fda8c43f21dd3979471/b8f3c93dd79c42ffa6d08a02cb5d9cd3.jpg, createdBy=68445539933, createdName=沧海 桑田, createdTime=Fri Jul 02 20:35:24 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=979035, encodeId=5ec39e903543, content=非常有用的,好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/b49b637ce90a455bb1e235f83924397b/5bf685e70c6643ba95249595009efb3d.jpg, createdBy=8ef85539728, createdName=DyralDeng, createdTime=Fri Jul 02 16:12:47 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026896, encodeId=49c2102689639, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048826, encodeId=662f104882650, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1823728, encodeId=177c1823e28b0, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jan 20 17:07:49 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=995492, encodeId=3967995492b9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/4850b6a0bb884fda8c43f21dd3979471/b8f3c93dd79c42ffa6d08a02cb5d9cd3.jpg, createdBy=68445539933, createdName=沧海 桑田, createdTime=Fri Jul 02 20:35:24 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=979035, encodeId=5ec39e903543, content=非常有用的,好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/b49b637ce90a455bb1e235f83924397b/5bf685e70c6643ba95249595009efb3d.jpg, createdBy=8ef85539728, createdName=DyralDeng, createdTime=Fri Jul 02 16:12:47 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026896, encodeId=49c2102689639, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048826, encodeId=662f104882650, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-02 沧海 桑田

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1823728, encodeId=177c1823e28b0, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jan 20 17:07:49 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=995492, encodeId=3967995492b9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/4850b6a0bb884fda8c43f21dd3979471/b8f3c93dd79c42ffa6d08a02cb5d9cd3.jpg, createdBy=68445539933, createdName=沧海 桑田, createdTime=Fri Jul 02 20:35:24 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=979035, encodeId=5ec39e903543, content=非常有用的,好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/b49b637ce90a455bb1e235f83924397b/5bf685e70c6643ba95249595009efb3d.jpg, createdBy=8ef85539728, createdName=DyralDeng, createdTime=Fri Jul 02 16:12:47 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026896, encodeId=49c2102689639, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048826, encodeId=662f104882650, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-02 DyralDeng

    非常有用的,好棒

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1823728, encodeId=177c1823e28b0, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jan 20 17:07:49 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=995492, encodeId=3967995492b9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/4850b6a0bb884fda8c43f21dd3979471/b8f3c93dd79c42ffa6d08a02cb5d9cd3.jpg, createdBy=68445539933, createdName=沧海 桑田, createdTime=Fri Jul 02 20:35:24 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=979035, encodeId=5ec39e903543, content=非常有用的,好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/b49b637ce90a455bb1e235f83924397b/5bf685e70c6643ba95249595009efb3d.jpg, createdBy=8ef85539728, createdName=DyralDeng, createdTime=Fri Jul 02 16:12:47 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026896, encodeId=49c2102689639, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048826, encodeId=662f104882650, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-02 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1823728, encodeId=177c1823e28b0, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Thu Jan 20 17:07:49 CST 2022, time=2022-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=995492, encodeId=3967995492b9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/4850b6a0bb884fda8c43f21dd3979471/b8f3c93dd79c42ffa6d08a02cb5d9cd3.jpg, createdBy=68445539933, createdName=沧海 桑田, createdTime=Fri Jul 02 20:35:24 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=979035, encodeId=5ec39e903543, content=非常有用的,好棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210702/b49b637ce90a455bb1e235f83924397b/5bf685e70c6643ba95249595009efb3d.jpg, createdBy=8ef85539728, createdName=DyralDeng, createdTime=Fri Jul 02 16:12:47 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026896, encodeId=49c2102689639, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048826, encodeId=662f104882650, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Fri Jul 02 16:07:49 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-02 junJUN

    老年人痴呆何药可用??

    0

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