Risk Factors for Atherothrombotic Brain Infarction in Persons Over 62 Years of Age in a Long‐Term Health Care Facility

Abstract

A history of systolic (greater than or equal to 160 mm Hg) or diastolic (greater than or equal to 90 mm Hg) hypertension, diabetes mellitus (fasting venous plasma glucose greater than or equal to 140 mg/dl), a history of cigarette smoking, fasting serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl, and obesity (greater than or equal to 20% above ideal body weight) were examined as risk factors for atherothrombotic brain infarction (ABI) in 144 men, mean age 81 +/- 8 years, and 391 women, mean age 82 +/- 8 years, in a long-term health care facility. ABI occurred in 33 of 144 men (23%) and in 68 of 391 women (17%), P not significant. A history of systolic or diastolic hypertension correlated with ABI in both men and women (P less than 0.001). Diabetes mellitus correlated with ABI in both men and women (P less than 0.001). A history of cigarette smoking correlated with ABI in men (P less than 0.02) but not in women. Serum total cholesterol greater than or equal to 200 mg/dl and greater than or equal to 250 mg/dl did not significantly correlate with ABI in men or in women. Obesity did not significantly correlate with ABI in men or in women. Systolic or diastolic hypertension, diabetes mellitus, and cigarette smoking are risk factors for ABI in elderly men. Systolic or diastolic hypertension and diabetes mellitus are risk factors for ABI in elderly women.

Elderly Subjects Aged 70 Years and Above Have Different Risk Factors for Ischemic and Hemorrhagic Strokes Compared to Younger Subjects

“…Although hypertension was found to be a risk factor for ischemic strokes in both age groups, it was a risk factor for intracerebral hemorrhage only in the younger group. This is in agreement with the study of elderly subjects (mean age 80 years) in a long‐term‐care facility showing that a past history of hypertension is a significant risk factor for atherothrombotic strokes, 7 and also with the prospective study of subjects aged 65–84 years by Khaw et al, 6 where systolic blood pressure was found to be a predictor of stroke‐associated mortality. No distinction between ischemic and hemorrhagic stroke was made in the latter study, however.…”

“…A history of diabetes mellitus, being a current smoker, and having evidence of left ventricular hypertrophy on electrocardiogram were significant risk factors for ischemic strokes in the young, but not the older group, suggesting that modification of these risk factors in the older group may not have much impact on the occurrence of the disease. This finding is different from that of previous studies, where diabetes and smoking were found to be risk factors in the elderly 5 – 7 . A decline in the association between diabetes and ischemic stroke with age may not be surprising since glucose intolerance becomes more common with increasing age, 14 and up to half of the subjects with diabetes may be undiagnosed 15 .…”

“…There are few studies of risk factors for stroke in the elderly. Two prospective studies 5 , 6 and one cross‐sectional study 7 examined risk factors for subjects aged 65 years and above, but did not analyze risk factors for stroke subtypes separately, nor compare the risk factors with those in younger age groups. In another prospective study examining only serum lipids as a risk factor in those aged 75 years or over, no significant association was found between lipids and stroke 8 .…”

Serum Total Cholesterol in Atherothrombotic Brain Infarction

“…To the Editor: —Woo et al 1 misread our paper 2 and stated, “In Aronow's study of atherothrombotic strokes, cholesterol was still a significant risk factor among a group of elderly subjects with a mean age of 80 years.” We stated in our paper 2 that “Our data showed that serum total cholesterol did not significantly correlate with atherothrombotic brain infarction in either elderly men or in elderly women. However, we did find that a serum total cholesterol ≥200 mg/dL and ≥250 mg/dL was a risk factor for coronary artery disease in both our elderly men and elderly women.” 3 We also reported in a prospective study of 192 men and 516 women, mean age 82 ± 8 years, that at 36‐month mean follow‐up “Data from our prospective study indicated that hypercholesterolemia, a low serum high‐density lipoprotein cholesterol, and hypertriglyceridemia did not significantly correlate with the development of new atherothrombotic brain infarction in elderly men or women.” 4 …”

Risk Factors Predisposing to Stroke in an Elderly Chinese Population – A Longitudinal Study

“…There are few studies of stroke risk factors among the elderly. Some have suggested that hyperten sion, diabetes, and smoking are still poten tially remedial risk factors even in the elderly [3][4][5], Other studies have not demonstrated this [6]. The only factor consistently found to predispose to stroke in the elderly is the presence of atrial fibrillation [6,7], Among the Chinese in Hong Kong, cere brovascular disease is the third commonest cause of death, following neoplasms and heart disease, the mortality rate among those aged 65 years and over being 513.8/100,000 in 1985.…”