Risk factors for cerebral infarction and cerebrovascular stenosis in antiphospholipid antibody-positive patients: A retrospective single-center study with propensity score matching analysis

Abstract

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPLA), such as anticardiolipin (aCL), anti-β2-glycoprotein I (aβ2GPI), or lupus anticoagulant (LA). Although cerebrovascular events are commonly associated with APS, comprehensive studies on risk factors for cerebral infarction in aPLA-positive patients remain sparse. In this retrospective single-center study, data from 9844 patients tested for aPLA between January 2017 and March 2023 were analyzed. A total of 647 aPLA-positive patients were included, with assessments of various factors including age, gender, hypertension, diabetes, dyslipidemia, smoking history, and cardiac disease. Propensity score matching was employed to create 2 matched groups of 202 patients each, comparing those with and without cerebral infarction. Logistic regression analyses were conducted to identify risk factors for cerebral infarction and progression of cerebrovascular stenosis. The mean age of the study cohort was 65.8 years, with 60% being male. LA was positive in 95.2% of the cases, aCL in 8.8%, and aβ2GPI in 5.3%. High-risk aPLA profiles were identified in 7.1% of the cases. In the cerebral infarction group, both smoking history and aCL positivity were significantly associated with an increased risk (OR = 1.543; 95% CI: 1.020-2.334; P = .040 and OR = 3.043; 95% CI: 1.426-6.491; P = .040, respectively). Male gender and posterior circulation involvement were significant risk factors for exacerbation of cerebrovascular stenosis (OR = 3.73; 95% CI: 1.16-16.69; P = .046 and OR = 5.41; 95% CI: 1.80-16.05; P = .002, respectively). Smoking history and aCL positivity are prominent risk factors for cerebral infarction in aPLA-positive patients, while male gender and involvement of the posterior circulation emerge as significant risk factors for the progression of cerebrovascular stenosis. Further comprehensive prospective studies are necessary to deepen understanding of aPLA-related cerebrovascular diseases.

Figure 1.

Flow chart of study participants.

Figure 2.

Cases in which cerebrovascular lesions progressed during the follow-up period were classified as “aggravation” as follows. For example, in a 72-year-old male patient, progression of basilar artery lesions was observed on follow-up magnetic resonance angiography 2 years and 2 months later (white arrow) in both (A) and (B).

Figure 3.

Logistic regression plot of odds ratios and 95% CIs. (A) multivariate logistic regression analysis of risk factors associated with infarction in aPLA- positive patients; (B) multivariate logistic regression analysis of risk factors associated with the aggravation of vessel stenosis in aPLA-positive patients with cerebral infarction.