Association between atherosclerotic disease and cervical artery dissection in a population‐based cohort of older people

• Published in: Annals of clinical and translational neurology Vol. 11; no. 12; pp. 3095 - 3102
• Main Authors: Kahan, Joshua, Zhang, Cenai, Liberman, Ava L., Segal, Alan Z., Murthy, Santosh B., Kim, Jiwon, Kamel, Hooman, Merkler, Alexander E.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.12.2024; John Wiley and Sons Inc; Wiley
• Subjects: Age; Aged; Aged, 80 and over; Atherosclerosis; Atherosclerosis - epidemiology; Beneficiaries; Cardiac arrhythmia; Cardiovascular disease; Chronic illnesses; Chronic obstructive pulmonary disease; Codes; Cohort Studies; Comorbidity; Coronary vessels; Diabetes; Dissection; Female; Health care policy; Heart failure; Humans; Hyperlipidemia; Hypertension; Kidney diseases; Male; Medicare; Medicare - statistics & numerical data; Older people; Patients; Population; Retrospective Studies; Risk Factors; Stroke; Survival analysis; Tobacco; United States - epidemiology; Vein & artery diseases; Vertebral Artery Dissection - epidemiology; United States
• ISSN: 2328-9503; 2328-9503
• DOI: 10.1002/acn3.52216

Objectives Many cases of cervical artery dissection are considered “spontaneous.” Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection. Methods We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time‐dependent confounding. Results Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40–2.41]), alcohol use (HR 1.83 [1.52–2.21]), atrial fibrillation (HR 1.80 [1.53–2.11]), tobacco use (HR 1.80 [1.52–2.13]), coronary artery disease (HR 1.56 [1.33–1.82]), and valvular heart disease (HR 1.23 [1.05–1.45]). Interpretation In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted.