Hoe calcificatie in de atherosclerotische aorta kan samengaan zowel met minder recidiefherseninfarcten in klinisch onderzoek als met een toegenomen aantal herseninfarcten in obductieonderzoek: interpretatie op basis van selectiebias

- Studies evaluating the role of calcification in the relationship between aortic atherosclerosis and stroke have led to contradictory conclusions: clinical studies show that aortic calcification is linked to a reduced risk of recurrence in stroke patients, while an autopsy series found a positive association between aortic calcification and stroke.

- The controversy can be explained by assuming that the risk associated with aortic atherosclerosis varies among individuals. Low-risk patients would live longer and have more time to develop calcification. Consequently, calcification would be a sign of low risk. This explains the apparent recurrence-reducing effect of calcification in stroke patients.

- The association between aortic calcification and stroke found in an autopsy series does not contradict this hypothesis but supports it: application of Berkson’s fallacy shows that calcification is linked to lower mortality.

Ned Tijdschr Geneeskd. 2008;152:198-201