Why the study?
To investigate the association of smoking, hypertension, diabetes mellitus, and hyperlipidemia with spontaneous cervical artery dissection compared to non-dissection ischemic stroke.
Are traditional cardiovascular risk factors (smoking, hypertension, diabetes, hyperlipidemia) less prevalent in spontaneous cervical artery dissection compared to non-dissection ischemic stroke?
Are traditional cardiovascular risk factors (smoking, hypertension, diabetes, hyperlipidemia) less prevalent in spontaneous cervical artery dissection compared to non-dissection ischemic stroke?
Traditional cardiovascular risk factors such as diabetes, hypercholesterolemia, and smoking are less strongly associated with spontaneous cervical artery dissection compared to other causes of ischemic stroke, whereas hypertension may be a shared risk factor.
Answers are grounded in this paper and cite their sources.
Traditional risk factor modification may not reduce sCeAD incidence; confirms distinct pathogenesis from atherosclerotic stroke.
This meta-analysis was conducted to investigate the association of smoking, hypertension, diabetes mellitus and hyperlipidemia with spontaneous cervical artery dissection (sCeAD) and non-dissection ischemic stroke (IS). We searched Medline, Embase and PubMed Central for studies that compared the four cardiovascular variables between sCeAD and non-dissection IS. Heterogeneity was quantified with χ2-based Cochran's Q-test and I2-statistic. We used fixed effects analysis when heterogeneity was low, and random effects model when high. Newcastle-Ottawa-Scale was used to assess the risk of bias and Cochrane RevMan 5.4 was used for analysis. Eighteen studies compared 1621 patients with ischemic stroke related to sCeAD with 8048 control patients with IS of other causes. Heterogeneity was 25% for diabetes, 40% for smoking, 49% for hypercholesterolemia and 83% for hypertension. The four cardiovascular variables showed a significant association with non-dissection IS compared to sCeAD. This was more pronounced for diabetes (pooled OR = 0.45 [0.35, 0.58], P-value <0.00001), hypercholesterolemia (pooled OR = 0.58 [0.48, 0.70] and smoking (pooled OR 0.63 [0.55, 0.71], P-value <0.00001). Hypertension also showed significant association with non-dissection ischemic stroke compared to sCeAD (pooled OR = 0.57 [0.40, 0.81], P-value =0.002), but this association was not statistically significant after sensitivity analysis. This meta-analysis showed that smoking diabetes and hypercholesterolemia were significantly associated with non-dissection than with dissection ischemic stroke. This association was not shown for hypertension, suggesting it is a risk factor of sCeAD as well as of ischemic stroke of other types.
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Abdelnour et al. (2022) studied this question.
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