Stroke Incidence and Association with Risk Factors in Women: a 32-year Follow-up of the Prospective Population Study of Women in Gothenburg

Overview

Journal BMJ Open

Specialty General Medicine

Date 2014 Oct 30

PMID 25351597

Citations 24

Authors

Ann Blomstrand

Christian Blomstrand

Nashmil Ariai

Calle Bengtsson

Cecilia Bjorkelund

Affiliations

Soon will be listed here.

Abstract

Objective: To study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors.

Design: Prospective population study initiated in 1968-1969 with follow-ups in 1974, 1980, 1992 and 2001.

Setting: Gothenburg, Sweden.

Participants: A sample of 1462 women from five age strata examined in 1968-1969, representative of women in the general population.

Main Outcome Measures: Main types of first-ever stroke and fatal stroke during 1968-2001 identified and validated. Stroke incidence rates in different age strata. Association with baseline smoking, body mass index (BMI), waist-hip ratio, hypertension, serum lipids, physical inactivity, perceived mental stress and education. Associations with atrial fibrillation (AF), diabetes, baseline hypertension and myocardial infarction (MI). Blood pressure (BP) levels 1-3, corresponding to modern guidelines, in relation to stroke risk.

Results: 184 (12.6%) cases of first-ever stroke, 33 (18%) of them fatal. Validation reduced unspecified stroke diagnoses from 37% to 11%. Age-standardised incidence rate per 100,000 person-years was 448. A multivariate model showed a significant association between ischaemic stroke and high BMI: HR 1.07 (95% CI 1.02 to 1.12), smoking 1.78 (1.23 to 2.57) and low education 1.17 (1.01 to 1.35). Significant association was seen between haemorrhagic stroke and, besides age, physical inactivity 2.18 (1.04 to 4.58) and for total stroke also hypertension 1.45 (1.02 to 2.08). Survival analysis showed a significantly increased risk of stroke in participants with diabetes (p<0.001), AF (p<0.001) and hypertension (p=0.001), but not MI. Stroke risk increased with increasing BP levels but was already seen for diastolic pressure grade 1 and particularly when combined with systolic BP grade 1; 1.62 (1.17 to 2.25).

Conclusions: Hypertension, smoking, AF, diabetes and high BMI were associated with increased stroke risk. Low education was associated with stroke. Validation of National Patient Registry diagnoses to increase specified diagnoses improved data quality.

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References

Bodenant M, Kuulasmaa K, Wagner A, Kee F, Palmieri L, Ferrario M . Measures of abdominal adiposity and the risk of stroke: the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. Stroke. 2011; 42(10):2872-7. DOI: 10.1161/STROKEAHA.111.614099. View

Hollander M, Koudstaal P, Bots M, Grobbee D, Hofman A, Breteler M . Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study. J Neurol Neurosurg Psychiatry. 2003; 74(3):317-21. PMC: 1738313. DOI: 10.1136/jnnp.74.3.317. View

ODonnell M, Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P . Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735):112-23. DOI: 10.1016/S0140-6736(10)60834-3. View

Harmsen P, Wilhelmsen L, Jacobsson A . Stroke incidence and mortality rates 1987 to 2006 related to secular trends of cardiovascular risk factors in Gothenburg, Sweden. Stroke. 2009; 40(8):2691-7. DOI: 10.1161/STROKEAHA.109.550814. View

Appelros P, Stegmayr B, Terent A . Sex differences in stroke epidemiology: a systematic review. Stroke. 2009; 40(4):1082-90. DOI: 10.1161/STROKEAHA.108.540781. View

Feigin V, Lawes C, Bennett D, Barker-Collo S, Parag V . Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009; 8(4):355-69. DOI: 10.1016/S1474-4422(09)70025-0. View

Li C, Hedblad B, Rosvall M, Buchwald F, Khan F, Engstrom G . Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position: a population-based study of middle-aged Swedish men and women. Stroke. 2008; 39(8):2191-6. DOI: 10.1161/STROKEAHA.107.507756. View

Hallstrom B, Jonsson A, Nerbrand C, Norrving B, Lindgren A . Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke. 2007; 39(1):10-5. DOI: 10.1161/STROKEAHA.107.491779. View

Hu G, Tuomilehto J, Silventoinen K, Sarti C, Mannisto S, Jousilahti P . Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke. Arch Intern Med. 2007; 167(13):1420-7. DOI: 10.1001/archinte.167.13.1420. View

10.

Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase C, Kannel W . Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA. 2006; 296(24):2939-46. DOI: 10.1001/jama.296.24.2939. View

11.

Kuper H, Adami H, Theorell T, Weiderpass E . The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke. 2006; 38(1):27-33. DOI: 10.1161/01.STR.0000251805.47370.91. View

12.

Fang M, Singer D, Chang Y, Hylek E, Henault L, Jensvold N . Gender differences in the risk of ischemic stroke and peripheral embolism in atrial fibrillation: the AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study. Circulation. 2005; 112(12):1687-91. PMC: 3522521. DOI: 10.1161/CIRCULATIONAHA.105.553438. View

13.

Rosengren A, Giang K, Lappas G, Jern C, Toren K, Bjorck L . Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke. 2013; 44(9):2388-93. DOI: 10.1161/STROKEAHA.113.001170. View

14.

Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M . 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31(7):1281-357. DOI: 10.1097/01.hjh.0000431740.32696.cc. View

15.

Jood K, Jern C, Wilhelmsen L, Rosengren A . Body mass index in mid-life is associated with a first stroke in men: a prospective population study over 28 years. Stroke. 2004; 35(12):2764-9. DOI: 10.1161/01.STR.0000147715.58886.ad. View

16.

Rankinen T, Kim S, Perusse L, Despres J, Bouchard C . The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord. 1999; 23(8):801-9. DOI: 10.1038/sj.ijo.0800929. View

17.

Rexrode K, Hennekens C, Willett W, Colditz G, Stampfer M, Rich-Edwards J . A prospective study of body mass index, weight change, and risk of stroke in women. JAMA. 1997; 277(19):1539-45. DOI: 10.1001/jama.1997.03540430051032. View

18.

Asplund K, Bonita R, Kuulasmaa K, Rajakangas A, Schaedlich H, Suzuki K . Multinational comparisons of stroke epidemiology. Evaluation of case ascertainment in the WHO MONICA Stroke Study. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Stroke. 1995; 26(3):355-60. DOI: 10.1161/01.str.26.3.355. View

19.

Aho K, Harmsen P, Hatano S, MARQUARDSEN J, Smirnov V, Strasser T . Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980; 58(1):113-30. PMC: 2395897. View

20.

Bengtsson C . Ischaemic heart disease in women. A study based on a randomized population sample of women and women with myocardial infarction in Göteborg, Sweden. Acta Med Scand Suppl. 1973; 549:1-128. View