Risk factors for stroke and myocardial infarction in women in the United Kingdom as assessed in general practice: a case-control study.

To determine the influence of family history on vascular disease, we surveyed hospital patients discharged with a diagnosis of transient ischemic attack. Of 117 respondents, 81 knew their family history for myocardial infarction and 81 knew their family history for stroke. Of 83 responding 43 reported a personal history of myocardial infarction, and of 85 responding 66 reported a personal history of stroke. As expected, there was an association between positive family and personal histories of myocardial infarction in younger (aged <70 years) patients (Fisher's two-tailed exact test, p=0.014). This association was reversed for stroke (Fisher's two-tailed exact test, p=0.017). Older (aged >70 years) patients had a stronger association between positive family and personal histories of stroke; 14 (74%) of 19 older patients with a positive personal history of stroke had a positive family history of stroke. The reason for this reversal in the relation between family and personal histories of stroke compared with myocardial infarction may relate to the older age at onset of most strokes, differing stroke subtypes in older age groups, or lower rates of fatal myocardial infarction. This study suggests that familial factors may be important in some subtypes of cerebrovascular disease. Familial effects may be different in vascular diseases of the heart and brain. (Stroke 1991;22:837-841)A ssessment of risk factors in different races, / \ sexes, and age groups can provide important J. \ . clues to the pathogenesis of cerebrovascular disease and provide direction for the development of preventive strategies. Strong familial risk factors, both genetic and environmental, have been implicated in coronary artery disease (CAD), especially in younger patients.12 Although strokes, both ischemic and hemorrhagic, have been observed to cluster in families, few studies have examined familial risks. Given the possible implications for preventive therapies, we began preliminary investigations into the familial risk of stroke in a high-risk population. Subjects and MethodsTo select a group at high risk for stroke, we surveyed all patients with a discharge diagnosis of transient ischemic attack (TLA) from Yale-New Haven Hospital, New Haven, Conn., for a 4-year period (January 1985-January 1989. Using the hospital's Received September 14, 1990; accepted March 18, 1991. Clinical Information System, patients were identified using the International Classification of Diseases coding for TIA as either a primary or secondary discharge diagnosis. A questionnaire was developed as part of a Department of Epidemiology project on risk factor modification after TIA. The questionnaire included information on personal and family histories of both myocardial infarction (MI) and stroke, as well as on common vascular risk factors. A positive family history was defined as a "yes" response to the question, "Has anyone in your immediate family (blood relative) had an Ml/stroke/hypertension/diabetes?" Specific information on which family members were affect...

supporting

confidence: 52%

Family history in patients with transient ischemic attacks.

Brass

Shaker

1991

“…16,[25][26][27]37,49 There is more uncertainty in studies investigating young stroke patients. Studies investigating only young and middle-aged patients with stroke 41,48,50,55,60,63,64 found a greater influence of family history of stroke compared with studies including older patients, but there was disagreement between the studies that stratified their patients by age and reported on the effect of family history of stroke in different age strata.…”

Section: Floßmann Et Al Genetic Epidemiology Of Ischemic Stroke 221mentioning

confidence: 84%

“…Five case-control studies 41,48,50,63,64 recruited only patients aged Ͻ70 years, 1 study recruited patients with stroke onset at Ͻ65 years, 60 1 study recruited patients with stroke onset at Ͻ50 years, 55 and 1 study reported family histories separately for patients aged Ͻ54 and Ն54 years. 68 The combined OR for these younger patient groups was nonsignificantly (Pϭ0.10) higher (OR, 1.93; 95% CI, 1.7 to 2.2; PϽ0.00001; heterogeneity Pϭ0.0001; 1240 patients; Figure 6) than the remainder (OR, 1.69; 95% CI, 1.6 to 1.8; PϽ0.00001; heterogeneity Pϭ0.00001).…”

Section: Influence Of Agementioning

confidence: 99%

Systematic Review of Methods and Results of Studies of the Genetic Epidemiology of Ischemic Stroke

Floßmann

Schulz

Rothwell

2004

339

251

Background and Purpose-To design appropriate molecular genetic studies, we first need to understand the genetic epidemiology of stroke. We therefore performed a systematic review of the literature to assess the heritability of stroke according to methodological quality of studies and to determine any heterogeneity in findings between studies and possible publication bias. Methods-We searched for twin studies and studies of family history of stroke using bibliographic databases and by hand-searching reference lists and journals. Odds ratios (ORs) for family history as a risk factor for stroke were calculated within studies and combined by meta-analysis. Heterogeneity between studies, methodological quality of studies, and the influence of the age at which stroke occurred in both probands and relatives were assessed. Results-We identified 53 independent studies (3 twin, 33 case-control, and 17 cohort). Monozygotic twins were more likely to be concordant than dizygotic twins (OR, 1.65; 95% CI, 1.2 to 2.3; Pϭ0.003). A positive family history was a risk factor for stroke in both case-control (OR, 1.76; 95% CI, 1.7 to 1.9; PϽ0.00001) and cohort (OR, 1.30; 95% CI, 1.2 to 1.5; PϽ0.00001) studies. However, there was major heterogeneity between studies (cohort Pϭ0.0001; case-control PϽ0.00001), with much stronger associations in small studies and methodologically less rigorous studies. Moreover, studies that reported insufficient data to allow meta-analysis tended to have found weaker associations. Family history of stroke was more frequent in studies that were confined to probands or relatives aged Ͻ70 years. However, few studies considered the number of affected and unaffected relatives, only 2 studies considered stroke phenotypes in detail, and only 19 studies (38%) adjusted associations for intermediate phenotypes.No twin study, only 5 cohort studies (26%), and 20 case-control studies (61%) differentiated between ischemic and hemorrhagic stroke in the proband. Family history of stroke was more frequent in large-and small-vessel stroke than in cardioembolic stroke. There were very few data on the influence of family history on stroke severity and no data on stroke recovery. Conclusions-Twin studies suggest a small genetic contribution to stroke, but reliable interpretation of published family history studies is undermined by major heterogeneity, insufficient detail, and potential publication and reporting bias.More detailed large-scale genetic epidemiology is required.

“…10 A British casecontrol study also failed to show an association between parity and risk of stroke. 11 Our study has several limitations. OC use and reproductive history were only measured at baseline.…”

Section: Discussionmentioning

confidence: 99%

Reproductive History, Oral Contraceptive Use, and the Risk of Ischemic and Hemorrhagic Stoke in a Cohort Study of Middle-Aged Swedish Women

Yang

Kuper

Sandin

et al. 2009

Background and Purpose-Controversy persists as to whether oral contraceptive (OC) use and reproductive history play a role in the etiology of stroke, particularly ischemic stroke. Our aim was to investigate this question in a cohort of middle-aged Swedish women. CIϭ0.8 to 6.8) and women recommended by a doctor to stop using OC for medical reasons (2.1, 0.9 to 5.0) compared with never users. Compared with nulliparous women, parous women had a statistically significant lower risk of hemorrhagic stroke (0.5, 0.2 to 0.8), but similar association was not found for ischemic stroke (0.9, 0.5 to 1.4). Conclusions-There was no significant association of OC use with ischemic or hemorrhagic stroke, and the parity was associated with reduced risk of hemorrhagic stroke but not with ischemic stroke. Methods-The