Determinants of Stroke in a General Male Population

Abstract

Background and Purpose— To further improve preventive strategies against stroke, there is a need for epidemiological long-term studies. The study aimed at a prospective investigation of stroke determinants in the general male population. Methods— During a period of 48 years, from 50 to 98 years of age, a population-based sample of 854 men was followed using repeated medical examinations, lifestyle questionnaires, data from hospital records and the National Cause of Death Register. Results— Determinants of ischemic stroke were atrial fibrillation (hazard ratio [HR], 6.61; 95% CI, 4.47–9.77); mother dead from cardiovascular disease (HR, 1.53; 1.09–2.17); high education (HR, 0.81; 0.69–0.96); and high physical activity level during leisure time (HR, 0.68; 0.50–0.93). For hemorrhagic stroke heart rate (HR, 1.04; 1.01–1.06) and mother dead from stroke (HR, 3.56; 1.43–8.87) constituted an increased risk. Statistically significant determinants for all stroke were atrial fibrillation (HR, 5.34; 3.68–7.75); high diastolic blood pressure (HR, 1.02; 1.01–1.03); high body weight (HR, 0.96; 0.94–0.99); high educational level (HR, 0.79; 0.68–0.92); wide waist circumference (HR, 1.04; 1.01–1.07); smoking (HR, 1.25; 1.06–1.48); mother dead from cerebrovascular disease (HR, 1.43; 1.05–1.94); and diabetes mellitus (HR, 1.65; 1.02–2.68). Of all men diagnosed with atrial fibrillation, 88% had a stroke during follow-up. Conclusions— Atrial fibrillation was by far the strongest determinant of stroke during 48 years of follow-up in a male population sample followed until the age of 98 years. The results warrant improved prophylaxis through intense treatment of modifiable determinants.

Prehospital assessment of suspected stroke and TIA: An observational study

“…Atrial fibrillation was more common among stroke patients in the univariable analysis but not in the multivariable analysis. This is somewhat surprisingly, since atrial fibrillation is considered to be the strongest risk factor for stroke . The reason for this might be the fact that atrial fibrillation often leads to more severe strokes, which are more likely to be correctly diagnosed by the EMS.…”

Risk Factors of Recurrent Stroke in Young and Middle-Aged Stroke Patients after Interventional Therapy

“…In recent years, the standardized incidence rate of stroke increases by 13.19% annually in China. Besides, the disease characteristics of stroke in China have changed with the changing social environment and epidemiological survey reports have shown that the onset age of stroke presents a younger trend, especially in southwest China, where the age of stroke onset is significantly earlier [ 2 ]. According to the World Health Organization (WHO) data, the number of stroke patients in China will increase from 1.8 million in 2010 to 5.4 million in 2030 [ 3 ], indicating that young and middle-aged residents have become a potential population of stroke in China.…”

Forty-four-year longitudinal study of stroke incidence and risk factors – the Prospective Population Study of Women in Gothenburg

“…We cannot rule out that socioeconomic factors might have influenced seeking hospital care pattern. Another limitation is that we have not studied risk factor load over time with different analyses such as in an earlier study on men [ 18 ]. Further, we cannot rule out that repeated examinations over long time may have affected the women’s awareness of risk factors.…”

“…Another cohort study in Swedish women showed an inverse association between risk of stroke and years of education [ 24 ] compatible with our study. In a population study of men born 1913 followed for 48 years, low education was strongly associated with stroke [ 18 ]. Our study showed a strong association between education and stroke whilst SEP did not show any association.…”