Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

O’Donnell, Martin; Chin, Siu Lim; Rangarajan, Sumathy; Xavier, Denis; Liu, Lisheng; Zhang, Hongye; Rao‐Melacini, Purnima; Zhang, Xiaohe; Пайс, Прем; Agapay, Steven; López‐Jaramillo, Patricio; Damasceno, Albertino; Langhorne, Peter; McQueen, Matthew; Rosengren, Annika; Dehghan, Mahshid; Hankey, Graeme J.; Dans, Antonio L.; ElSayed, Ahmed; Avezum, Álvaro; Mondo, Charles; Diener, Hans‐Christoph; Ryglewicz, Danuta; Członkowska, Anna; Pogosova, Nana; Weimar, Christian; Iqbal, Romaina; Dı́az, Rafael; Yusoff, Khalid; Yusufali, Afzalhussein; Oğuz, Aytekin; Wang, Xingyu; Peñaherrera, Ernesto; Lanas, Fernando; Ogah, Okechukwu S; Ogunniyi, Adesola; Iversen, Helle K.; Málaga, Germán; Rumboldt, Zvonko; Oveisgharan, Shahram; Hussain, Fawaz Al; Magazi, Daliwonga Sithembele; Nilanont, Yongchai; Ferguson, John; Paré, Guillaume; Yusuf, Salim

doi:10.1016/s0140-6736(16)30506-2

Cited by 1,536 publications

(1,374 citation statements)

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“…However, we infer that the magnitude of hypertensive subclinical organ damage markers for CVD incidence would be similar in other countries where CVD is a major burden, because HT is the most prevalent risk factor for stroke across major regions of the world. 24 Fifth, among the surveyed areas, Noichi had a short follow-up period for ascertainment of CVD because of discontinuation of the investigation in 2005 resulting from municipal mergers. However, when we excluded the subjects (2,582 residents at risk, 59 stroke and 19 CAD events) from Noichi, the magnitude of the association between each risk factor and the incidence of CVD was similar to the present findings that included the subjects from Noichi, while retaining the proportionality of a Cox proportional hazard model (data not shown).…”

Section: Study Limitationsmentioning

confidence: 99%

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Kitamura

Yamagishi

Imano

et al. 2017

Circ J

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on behalf of the CIRCS InvestigatorsBackground: In Japan, a community-based screening program for cardiovascular disease (CVD) has been effective in preventing stroke and coronary artery disease (CAD). The present study aimed to clarify which risk factors assessed at the screening examinations affect the incidence of CVD and the magnitude of the association after the late 1990 s. Methods and Results:We conducted a 12.5-year prospective study of 10,612 Japanese residents aged 40-74 years between 1995 and 2000, initially free of CVD and who underwent the screening examinations. During the follow-up, 364 cases of stroke and 137 cases of CAD were identified. The population attributable fraction of stroke was the largest for hypertension (HT; 46%), while the relative risk of stroke was the highest for atrial fibrillation (multivariable hazard ratio, 4.9; 95% confidence interval, 2.9-8.3). The population attributable fraction of CAD was relatively large for HT, current smoking, and high non-high-density lipoprotein cholesterol (20-29%). A dose-response relationship was found between the incidence of these cardiovascular events and the number of comorbid hypertensive subclinical organ damage markers: funduscopic changes, ST-T changes on ECG at rest, proteinuria and low estimated glomerular filtration rate.Conclusions: HT and hypertensive subclinical organ damage are significantly associated with incident stroke and CAD at the population level, suggesting that management of HT and assessment of subclinical organ damage in hypertensive subjects at a screening program are still beneficial for community-based CVD prevention.

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Section: Study Limitationsmentioning

confidence: 99%

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Kitamura

Yamagishi

Imano

et al. 2017

Circ J

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“…Only recent studies have provided evidence that established stroke risk factors are more common in the young than previously assumed. 3,[9][10][11][12][13] The contribution of cardiovascular risk factors to the overall stroke risk was assessed previously. [13][14][15][16] Depending on the number of included risk factors, ≈90% of strokes can be explained by high blood pressure, smoking, obesity, diet, physical inactivity, diabetes mellitus, alcohol consumption, mental distress, heart disease, and lipid disorders.…”

mentioning

confidence: 99%

“…3,[9][10][11][12][13] The contribution of cardiovascular risk factors to the overall stroke risk was assessed previously. [13][14][15][16] Depending on the number of included risk factors, ≈90% of strokes can be explained by high blood pressure, smoking, obesity, diet, physical inactivity, diabetes mellitus, alcohol consumption, mental distress, heart disease, and lipid disorders. [13][14][15][16] However, these studies were mostly conducted in older populations, whereas stroke in the young is generally assumed to differ in risk factors and pathogenesis.…”

mentioning

confidence: 99%

“…[13][14][15][16] Depending on the number of included risk factors, ≈90% of strokes can be explained by high blood pressure, smoking, obesity, diet, physical inactivity, diabetes mellitus, alcohol consumption, mental distress, heart disease, and lipid disorders. [13][14][15][16] However, these studies were mostly conducted in older populations, whereas stroke in the young is generally assumed to differ in risk factors and pathogenesis. 3,17,18 The INTERSTROKE study recently provided evidence for the importance of established stroke risk factors for stroke in the young in a subgroup analysis.…”

mentioning

confidence: 99%

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Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults

Aigner

Grittner

Rolfs

et al. 2017

Stroke

169

154

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Background and Purpose-As stroke in young adults is assumed to have different etiologies and risk factors than in older populations, the aim of this study was to examine the contribution of established potentially modifiable cardiovascular risk factors to the burden of stroke in young adults. Methods-A German nationwide case-control study based on patients enrolled in the SIFAP1 study (Stroke In Young Fabry Patients) 2007 to 2010 and controls from the population-based GEDA study (German Health Update) 2009 to 2010 was performed. Cases were 2125 consecutive patients aged 18 to 55 years with acute first-ever stroke from 26 clinical stroke centers; controls (age-and sex-matched, n=8500, without previous stroke) were from a nationwide community sample. Adjusted population-attributable risks of 8 risk factors (hypertension, hyperlipidemia, diabetes mellitus, coronary heart disease, smoking, heavy episodic alcohol consumption, low physical activity, and obesity) and their combinations for all stroke, ischemic stroke, and primary intracerebral hemorrhage were calculated. Results-Low physical activity and hypertension were the most important risk factors, accounting for 59.7% (95% confidence interval, 56.3-63.2) and 27.1% (95% confidence interval, 23.6-30.6) of all strokes, respectively. All 8 risk factors combined explained 78.9% (95% confidence interval, 76.3-81.4) of all strokes. Population-attributable risks of all risk factors were similar for all ischemic stroke subtypes. Population-attributable risks of most risk factors were higher in older age groups and in men. Conclusions-Modifiable risk factors previously established in older populations also account for a large part of stroke in younger adults, with 4 risk factors explaining almost 80% of stroke risk. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583.

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“…A large international study recently identified hypertension, lack of exercise and elevated serum lipids as the most significant risk factors for an acute stroke (2). Attention to these and other independent stroke predictors including diabetes mellitus, obesity, smoking and cardiovascular disease decreased stroke incidence in the last 30 years (3).…”

Section: Introductionmentioning

confidence: 99%

Acute Ischemic Stroke Management Review for the Hospitalist

Haldal¹,

Beary²,

Nattanmai³

et al. 2018

Am J Hosp Med

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Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Cited by 1,536 publications

References 44 publications

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults

Acute Ischemic Stroke Management Review for the Hospitalist

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Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Cited by 1,536 publications

References 44 publications

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels ― The Circulatory Risk in Communities Study (CIRCS) ―

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels ― The Circulatory Risk in Communities Study (CIRCS) ―

Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults

Acute Ischemic Stroke Management Review for the Hospitalist

Contact Info

Product

Resources

About

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―

Impact of Hypertension and Subclinical Organ Damage on the Incidence of Cardiovascular Disease Among Japanese Residents at the Population and Individual Levels　― The Circulatory Risk in Communities Study (CIRCS) ―