Citations

ObjectiveEpidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent.Methods and ResultsIn the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.3 years, men = 56.7%) prospectively recruited at 39 Italian centers with those of 2 control groups, composed of (1) patients whose ischemic stroke was caused by mechanisms other than dissection (non‐CeAD IS) selected from the prospective IPSYS registry and Brescia Stroke Registry and (2) stroke‐free individuals selected from the staff members of participating hospitals, matched 1:1:1 by sex, age, and race. Compared to stroke‐free subjects, patients with sCeAD were more likely to be hypertensive (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.37–1.98), to have personal history of migraine with aura (OR = 2.45, 95% CI = 1.74–3.34), without aura (OR = 2.67, 95% CI = 2.15–3.32), and family history of vascular disease in first‐degree relatives (OR = 1.69, 95% CI = 1.39–2.05), and less likely to be diabetic (OR = 0.65, 95% CI = 0.47–0.91), hypercholesterolemic (OR = 0.75, 95% CI = 0.62–0.91), and obese (OR = 0.41, 95% CI = 0.31–0.54). Migraine without aura was also associated with sCeAD (OR = 1.81, 95% CI = 1.47–2.22) in comparison with patients with non‐CeAD IS. In the subgroup of patients with migraine, patients with sCeAD had higher frequency of migraine attacks and were less likely to take anti‐migraine preventive medications, especially beta‐blockers, compared with the other groups.InterpretationThe risk of sCeAD is influenced by migraine, especially migraine without aura, more than by other factors, increases with increasing frequency of attacks, and seems to be reduced by migraine preventive medications, namely beta‐blockers. ANN NEUROL 2023;94:585–595

Background Uterine fibroids ( UF s) are the most common neoplasm affecting women that can cause significant morbidity and may adversely impact fertility. Objectives To examine UF epidemiology and to evaluate the relative strengths of putative risk factors. Search strategy MEDLINE and Embase were searched for studies published in English between January 1995 and April 2015. Selection criteria Publications reporting relevant data from registries and other observational studies with over 1000 patients and single‐centre studies with over 100 patients were selected. Data collection and analysis Data on UF incidence, prevalence and associated risk factors were extracted from 60 publications. Main results Wide ranges were reported in both UF incidence (217–3745 cases per 100 000 women‐years) and prevalence (4.5–68.6%), depending on study populations and diagnostic methods. Black race was the only factor that was recurrently reported to increase UF risk, by two–threefold compared with white race. Eleven other factors affected UF risk to a magnitude similar to or greater than race. Age, premenopausal state, hypertension, family history, time since last birth, and food additive and soybean milk consumption increased UF risk; use of oral contraceptives or the injectable contraceptive depot medroxyprogesterone acetate, smoking in women with low body mass index and parity reduced UF risk. Conclusions We identified 12 risk factors that play an important role in UF epidemiology. The UF risk factor with the strongest evidence is black race. High‐quality prospective observational data are needed to improve our understanding of UF epidemiology, and thus its aetiology and optimal management. Tweetable abstract Uterine fibroids occur in about 70% of women. Black race and 11 other factors affect uterine fibroid risk.