title: Parkinson's disease is related to an increased risk of ischemic stroke-a population-based propensity score-matched follow-up study.
abstract: OBJECTIVE
  The risk of stroke in patients with Parkinson's disease (PD) remains controversial. The purpose of this population-based propensity score-matched longitudinal follow-up study was to determine whether there is an increased risk of ischemic stroke after PD.
  
  
  METHODS
  We used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 2204 patients with at least two ambulatory visits with the principal diagnosis of PD in 2001 was enrolled in the PD group. The non- PD group consisted of 2204, propensity score-matched subjects without PD. The ischemic stroke-free survival rates of the two groups were estimated using the Kaplan-Meier method. Stratified Cox proportional hazard regression with patients matched on propensity score was used to estimate the effect of PD on the occurrence of ischemic stroke.
  
  
  RESULTS
  During the three-year follow-up period, 328 subjects in the PD group and 156 subjects in the non-PD group developed ischemic stroke. The ischemic stroke-free survival rate of the PD group was significantly lower than that of the non-PD group (P<0.0001). The hazard ratio (HR) of stroke for the PD group was 2.37 (95% confidence interval [CI], 1.92 to 2.93, P<0.0001) compared to the non- PD group.
  
  
  CONCLUSIONS
  This study shows a significantly increased risk of ischemic stroke in PD patients. Further studies are required to investigate the underlying mechanism.
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Huang
authors.forename: Li-Sheng
authors.initials: LS
authors.lastname: Chen
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Yen
authors.forename: Ching-Yuan
authors.initials: CY
authors.lastname: Fann
authors.forename: Yueh-Hsia
authors.initials: YH
authors.lastname: Chiu
authors.forename: Hsiu-Hsi
authors.initials: HH
authors.lastname: Chen
authors.forename: Shin-Liang
authors.initials: SL
authors.lastname: Pan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000209:etiology; D057216:Propensity Score; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology*
references.citation: Stroke. 2005 Apr;36(4):768-72
references.pmid: 15746456
references.citation: J Toxicol. 2011;2011:683728
references.pmid: 21785590
references.citation: Ann Neurol. 2003;53 Suppl 3:S26-36; discussion S36-8
references.pmid: 12666096
references.citation: Stroke. 1992 Jun;23(6):839-42
references.pmid: 1595102
references.citation: Cell. 2001 Feb 23;104(4):503-16
references.pmid: 11239408
references.citation: Diabetes Care. 2011 Dec;34(12):2614-23
references.pmid: 22110170
references.citation: Neurology. 2012 May 8;78(19):1507-11
references.pmid: 22539572
references.citation: Mov Disord. 2002 Jul;17(4):772-4
references.pmid: 12210874
references.citation: Parkinsonism Relat Disord. 2011 Dec;17(10):724-9
references.pmid: 21571570
references.citation: Neurology. 2008 Apr 15;70(16 Pt 2):1423-30
references.pmid: 18413567
references.citation: Stroke. 1990 Oct;21(10):1395-9
references.pmid: 2219202
references.citation: Parkinsonism Relat Disord. 2010 Jan;16(1):31-5
references.pmid: 19640771
references.citation: Mov Disord. 2001 Jan;16(1):119-23
references.pmid: 11215570
references.citation: Pharmacoepidemiol Drug Saf. 2011 Mar;20(3):236-42
references.pmid: 21351304
references.citation: J Urban Health. 2007 Jul;84(4):604-14
references.pmid: 17492511
references.citation: PLoS One. 2012;7(11):e49343
references.pmid: 23185317
references.citation: Neurology. 1994 Oct;44(10):1865-8
references.pmid: 7936238
references.citation: J Neurol Sci. 2009 Oct 15;285(1-2):118-20
references.pmid: 19573878
references.citation: Stroke. 2000 Oct;31(10):2307-13
references.pmid: 11022055
references.citation: Neurology. 2011 Oct 25;77(17):1605-10
references.pmid: 21998318
references.citation: Diabetes Care. 2012 May;35(5):1047-9
references.pmid: 22432112
references.citation: Occup Environ Med. 2005 Jul;62(7):500-6, 472
references.pmid: 15961628
references.citation: Hypertension. 2011 Jun;57(6):1094-100
references.pmid: 21536985
references.citation: PLoS One. 2011 Feb 17;6(2):e16103
references.pmid: 21379581
references.citation: Stat Med. 1998 Oct 15;17(19):2265-81
references.pmid: 9802183
references.citation: Diabetes Care. 2011 May;34(5):1102-8
references.pmid: 21411503
references.citation: Arch Neurol. 2010 Jan;67(1):33-8
references.pmid: 19901154
references.citation: Neurology. 1989 Jan;39(1):30-4
references.pmid: 2909910
references.citation: Neurology. 2010 Mar 16;74(11):878-84
references.pmid: 20220126
references.citation: JAMA. 1988 Feb 19;259(7):1025-9
references.pmid: 3339799
references.citation: Arch Neurol. 2003 Jan;60(1):91-6
references.pmid: 12533094
references.citation: Parkinsonism Relat Disord. 2011 Sep;17(8):625-8
references.pmid: 21689962
references.citation: PLoS One. 2009;4(3):e4756
references.pmid: 19270741
references.citation: J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):293-9
references.pmid: 7897409
references.citation: Am J Cardiol. 2003 Feb 6;91(3A):7A-11A
references.pmid: 12645638
references.citation: Stroke. 2001 May;32(5):1098-103
references.pmid: 11340216
references.citation: Neurology. 2001 Dec 26;57(12):2278-82
references.pmid: 11756610
references.citation: Circulation. 2001 Nov 27;104(22):2673-8
references.pmid: 11723017
references.citation: Stroke. 2006 May;37(5):1184-8
references.pmid: 16574924
references.citation: Arch Neurol. 2000 Apr;57(4):507-12
references.pmid: 10768625
references.citation: Int J Epidemiol. 2000 Oct;29(5):891-8
references.pmid: 11034974