Artikel
Modifiable cardiovascular risk factors and haemorrhage risk in patients with familial cavernous malformation
Einfluss modifizierbarer kardiovaskulärer Risikofaktoren auf das Blutungsrisiko bei Patienten mit familiären kavernösen Malformationen
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Autoren
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Bixia Chen
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Dino-Vitali Saban
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Annika Herten
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Alejandro Santos Saint Germain
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Steffen Rauscher
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Laurèl Rauschenbach
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Ramazan Jabbarli
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Karsten Henning Wrede
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Ulrich Sure
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
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Philipp Dammann
- Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: This study aims to assess the influence of modifiable cardiovascular risk factors on hemorrhage risk in patients with familial cavernous malformations (CMs).
Methods: From a register of 1345 CM patients (2003-2020), subjects with familial CMs and complete MRI data were included. We evaluated presence of intracerebral hemorrhage (ICH) as mode of presentation, occurrence of ICH during follow-up and risk factors arterial hypertension, diabetes mellitus, hyperlipidemia, nicotine abuse, and obesity (BMI>30kg/m²). Impact of risk factors on ICH at presentation was calculated using univariate and multivariate logistic regression with age- and sex-adjustment. We performed Kaplan Meier and Cox regression to analyze cumulative 5-year-risk for (re-)bleeding.
Results: We included 229 patients with familial CMs. In our cohort, 56.8% were female, 51.6% presented with ICH as mode of presentation, 27.3% suffered from cavernoma related epilepsy, and 30.1% were asymptomatic. Lesion were located supratentorial (78.1%), in the brain stem (12.1%), cerebellar (4.5%), and spinal (4.0%), risk factor distribution was comparable with the normal population: hypertension (27.0%), diabetes (7.4%), hyperlipidemia (12.2%), nicotine abuse (23.1%), and obesity (17.8%). Thirty percent underwent surgical treatment, 10.8% suffered from (re-)bleeding during the 5-year follow-up period (cumulative 5-year risk 20%).
The univariate logistic regression and multivariate adjusted logistic regression did not show significant relationships between all risk factors and ICH as mode of presentation. Cox regression did not identify predictors for occurrence of (re-)hemorrhage. The Kaplan-Meier regression (see Figure 1 [Fig. 1]) and log rank test showed a tendency towards a lower hemorrhage risk in patients with obesity in the longitudinal outcome without reaching statistical significance (χ²=2.899, p=0.089), neither did the other risk factors reach statistical significance: hypertension (χ²=0.462, p=0.497), diabetes (χ²=0.267, p=0.605), hyperlipidemia (χ²=0.001, p=0.972), and nicotine abuse (χ²=0.035, p=0.852).
Conclusion: In contrast to patients with sporadic cavernous malformations, obese patients with familial CMs showed a trend towards less hemorrhagic events during a 5-year follow-up period in our cohort.
