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　　最新的證據提示現有最好的藥物治療可能足以預防無癥狀性頸動脈狹窄患者卒中的發生。如果真是這樣的，那么確定治療所降低的風險就顯得至關重要。為此，英國圣喬治大學卒中與癡呆研究中心的Alice King博士等人進行了一項研究，研究結果于近日在線發表在Stroke雜志上。結果發現：抗血小板治療和血壓控制是降低無癥狀頸動脈狹窄患者短期卒中和心血管風險的最重要因素。

　　該研究為無癥狀性頸動脈栓塞研究（ACES）前瞻性數據，用來確定現有治療的效果和以后卒中或TIA的危險因素。研究人員對477位無癥狀性頸動脈狹窄的患者隨訪2年（每6個月隨訪1次）。每次隨訪危險因素的改變，并了解卒中預防止療方案。使用時間依賴Cox回歸確定現有治療隨著時間推移，與卒中、短暫性腦缺血發作和心血管死亡終點的相關性，以風險比和95%可信區間來表示。

　　研究結果顯示：在多變量分析中，抗血小板藥物(P=0.001)和較低的平均血壓(P=0.002)是單側卒中和短暫性腦缺血發作風險降低的獨立預測因素。抗血小板藥物(P<0.0001)和降壓藥(P<0.0001)是所有卒中和心血管死亡風險降低的獨立預測因素。

　　該研究發現：抗血小板治療和血壓控制是降低無癥狀頸動脈狹窄患者短期卒中和心血管風險的最重要因素。目前用于無癥狀性頸動脈狹窄的藥物（特別是他汀類），需要的更多的前瞻性數據進行驗證。

　　The Effect of Medical Treatments on Stroke Risk in Asymptomatic Carotid Stenosis

　　Alice King, PhD, Martin Shipley, MSc, Hugh Markus, FRCP, for the ACES Investigators

　　Background and Purpose—Recent evidence suggests current best medical treatment may be sufficient to prevent stroke in patients with asymptomatic carotid stenosis. If this is the case, then it is important to determine risk reduction provided by treatments. Using Asymptomatic Carotid Emboli Study (ACES) prospective data, the effect of current treatment and risk factors on future stroke and transient ischemic attack risk were determined. Methods—Four-hundred seventy-seven patients with asymptomatic carotid stenosis were followed-up every 6 months for 2 years. Changes in risk factors and stroke prevention therapies were reviewed at each visit. Using time-dependent Cox regression, the relationship between current treatment over time was determined and presented as hazard ratios and 95% confidence intervals for risk of stroke, transient ischemic attack, and cardiovascular death end points. Results—On multivariate analysis, antiplatelets (P=0.001) and lower mean blood pressure (P=0.002) were independent predictors of reduced risk of ipsilateral stroke and transient ischemic attack. Antiplatelets (P<0.0001) and antihypertensives (P<0.0001) were independent predictors of a lower risk of any stroke or cardiovascular death. Conclusions—Antiplatelet therapy and blood pressure control are the most important factors in reducing short-term stroke and cardiovascular risk in patients with asymptomatic carotid stenosis. More prospective data are required for medical treatments in asymptomatic carotid stenosis in particular for current statin usage.