Epidemiology of stroke

Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic hypertension and elevated pulse pressure also play an important role in the development of brain complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin-

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“…Research on stroke has been confused by the lack of standardised classification of stroke subtypes. 1 …”

Section: Definition and Methodolological Issuesmentioning

confidence: 99%

Cerebral complications of hypertension

Rigaud

Staessen

et al. 2000

J Hum Hypertens

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Section: Introductionmentioning

confidence: 99%

“…1 Several factors may increase the risk for stroke events, including high blood pressure, diabetes mellitus, physical inactivity, cigarette smoking and abnormal fibrinogen and homocysteine levels. 1,2 Since treatment options are relatively limited, public health strategies focus on the prevention of stroke by the modification of the traditional risk factors. 1 Increased left ventricular mass is now considered as an independent predictor of coronary heart disease (CHD) and stroke, [3][4][5] but the mechanisms responsible for this association are not well understood.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Since treatment options are relatively limited, public health strategies focus on the prevention of stroke by the modification of the traditional risk factors. 1 Increased left ventricular mass is now considered as an independent predictor of coronary heart disease (CHD) and stroke, [3][4][5] but the mechanisms responsible for this association are not well understood. 4 Recent studies suggest that physical activity may protect against stroke.…”

Section: Introductionmentioning

confidence: 99%

“…4 Recent studies suggest that physical activity may protect against stroke. 1,2 This protection may be due to the favourable effects of exercise on several risk factors associated with the risk of stroke, 2 including reduction in left ventricular mass of hypertensive patients. 6 Recently, a case-control study 5 reported that physical activity decreases the risk of stroke in patients with increased left ventricular mass to a level comparable to that of patients without increased left ventricular mass.…”

Section: Introductionmentioning

confidence: 99%

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Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961–2001) of the Seven Countries Study (the Corfu cohort)

et al. 2004

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Left ventricular hypertrophy (LVH) is a dominant characteristic of cardiovascular mortality. We investigated the interaction between physical activity and LVH on stroke mortality, based on a 40-year follow-up of the Corfu cohort from the Seven Countries Study. The population studied consisted of 529 rural men (40-59 years old) enrolled in the Study at 1961. LVH was electrographically confirmed according to Minnesota coding. Physical activity levels were assessed by selfreports of habitual, occupational and leisure-time activities. Cox proportional hazard models were used to evaluate exercise levels with respect to stroke mortality in people with and without LVH. During the follow-up, 461 (87%) died, and 74 (16%) of these deaths were due to stroke. LVH was present in 40 (7.5%) men. A total of 362 (68%) men were defined as physically active. Physical activity was associated with a lower risk of stroke (hazard ratio ¼ 0.65, Po0.05). On the other hand, LVH had 5.8-fold the risk of stroke (Po0.001) among sedentary and 4.5-fold the risk (Po0.001) among physically active men, after controlling for several potential confounders. However, moderate physical activity decreased the risk of stroke by 49% in men with LVH as compared to sedentary without LVH (hazard ratio ¼ 0.51, Po0.01), while hard exercise did not confer any significant reduction in stroke risk. We revealed the benefits from moderate physical activity on stroke mortality among men with LVH. Physicians and other health-care professionals should encourage patients with LVH to adopt a physically active lifestyle.

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Alcohol Consumption and Risk of Stroke

Reynolds

Lewis²,

Nolen³

et al. 2003

JAMA

790

484

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Context Observational studies suggest that heavy alcohol consumption may increase the risk of stroke while moderate consumption may decrease the risk.Objective To examine the association between alcohol consumption and relative risk of stroke.Data Sources Studies published in English-language journals were retrieved by searching MEDLINE (1966-April 2002 using Medical Subject Headings alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke; Dissertation Abstracts Online using the keywords stroke and alcohol; and bibliographies of retrieved articles. Study SelectionFrom 122 relevant retrieved reports, 35 observational studies (cohort or case control) in which total stroke, ischemic stroke, or hemorrhagic (intracerebral or total) stroke was an end point; the relative risk or relative odds and their variance (or data to calculate them) of stroke associated with alcohol consumption were reported; alcohol consumption was quantified; and abstainers served as the reference group.Data Extraction Information on study design, participant characteristics, level of alcohol consumption, stroke outcome, control for potential confounding factors, and risk estimates was abstracted independently by 3 investigators using a standardized protocol. Data SynthesisA random-effects model and meta-regression analysis were used to pool data from individual studies. Compared with abstainers, consumption of more than 60 g of alcohol per day was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke. ConclusionsThese results indicate that heavy alcohol consumption increases the relative risk of stroke while light or moderate alcohol consumption may be protective against total and ischemic stroke.

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Epidemiology of stroke

Cited by 313 publications

References 16 publications

Cerebral complications of hypertension

Cerebral complications of hypertension

Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961–2001) of the Seven Countries Study (the Corfu cohort)

Alcohol Consumption and Risk of Stroke

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