Urinary calculi and an increased risk of stroke: a population‐based follow‐up study

Abstract

E 1 0 5 3What ' s known on the subject? and What does the study add? Although early studies failed to detect an association between urinary calculi (UC) and subsequent cardiovascular risk, there is growing evidence among more recent research supporting this association with some studies more specifi cally suggesting that stroke is a major concern for UC sufferers. After adjusting for potential confounding factors, UC patients were more likely to have experienced a stroke then those without UC during the fi ve-year follow-up period (hazard ratio = 1.43, 95% Cl = 1.35 -1.50, P < 0.001). OBJECTIVE• To examine in a population-based study the relationship between a history of nephrolithiasis and/or ureterolithiasis and the subsequent risk of stroke, as previous studies have shown that stone disease is associated with several cardiovascular risk factors. However, none of the studies that have investigated the relationship between urinary calculi (UC) and stroke were able to detect an association at a signifi cant level. PATIENTS AND METHODS• We used data sourced from the Taiwan Longitudinal Health Insurance Database 2000.• In all, 25 181 adult patients newly diagnosed with UC were recruited as a study cohort, along with 125 905 matched enrolees with no history of stone disease as a comparison cohort.• All the subjects were tracked for a 5-year period beginning from their index ambulatory care visits, and those who subsequently had a stroke identifi ed.• Cox proportional hazards regressions were used to compare the risk of stroke between the study and comparison cohorts. RESULTS• During the 5-year follow-up period, the incidence rate of stroke was 1.78 (95% confi dence interval [ CI ] 1.71 -1.86) per 100 person-years in patients with UC and 1.25 (95% CI 1.22 -1.27) per 100 person-years in patients without UC.• After adjusting for hypertension, diabetes, hyperlipidaemia, cardiovascular disease, urbanization level, gout, and obesity, patients with UC were more likely to have had a stroke than those without UC during the 5-year follow-up period (hazard ratio 1.43, 95% CI 1.35 -1.50, P < 0.001). CONCLUSION• Our results suggest that there is an increased risk of stroke during the fi rst 5 years after a diagnosis of UC. KEYWORDSurinary calculi , stroke , epidemiology Study Type -Prognosis (cohort) Level of Evidence 2b

Association between Ischemic Stroke and Iron-Deficiency Anemia: A Population-Based Study

“…These co-morbidities have all been reported to be risk factors for stroke. In addition, similar multivariate-model has been used to estimate the risk of stroke by prior studies [21-23]. Furthermore, separate conditional logistic regression analyses (conditioned on sex, age group, and index year) were used to calculate the odds ratio (OR) for having been previously diagnosed with IDA between cases and controls.…”

Relationship between renal calculi and the risk of myocardial infarction and stroke: results from the EPIC-Potsdam study

“…Further, the presence of renal calculi was assessed by self-report at baseline. In contrast to the present investigation, previous studies [20][21][22][23] used participants with newly diagnosed incident renal calculi, thereby minimizing the threat of exposure misclassification. Furthermore, data on calculi composition and severity of stone disease are missing.…”

“…However, another explanation for the observed risk increase may be merely due to sharing similar risk factors [22], as these were only roughly captured. In another recent study in Taiwan [23], an increased risk of stroke during the first five years after a diagnosis of urinary calculi was reported compared to matched controls. However, the authors did not take into account lifestyle factors such as smoking, physical activity and alcohol consumption.…”

“…These findings could have clinical implications as the occurrence of renal calculi may indicate an increased risk of future cardiovascular events and could prompt preventive measures. However, data on the association between renal calculi and myocardial infarction and stroke are sparse [20][21][22][23]. To shed more light on this issue the relationship between prevalent renal calculi and the risk of myocardial infarction and stroke was investigated in a large German population-based cohort.…”

Pediatric nephrolithiasis and the link to bone metabolism

“…Nephrolithiasis is increasingly recognized as a multisystem condition involving the kidney, bone and vasculature. Adults with nephrolithiasis have been known to be at risk for bone demineralization since the 1970s and recently identified to be at risk for chronic kidney disease and atherosclerosis [7][8][9][10].…”