Abstract
BackgroundComorbidities, any other coexisting diseases in patients with a particular index disease, are known to increase the mortality of a stroke. However, the association of pre-existing comorbidities with stroke risk has not been fully studied.MethodsThis study included 16,246 adults from a prospective community-based cohort with a baseline survey conducted in 2013 in China. Participants were followed up with hospitalization records and the Cause of Death Registry. The association of eight pre-existing comorbidities (coronary heart disease, hyperlipidemia, hypertension, diabetes, previous stroke, chronic obstructive pulmonary disease, nephropathy, and cancer) with stroke risk was analyzed using the Cox proportional hazard model in 2020.ResultsAt a median follow-up of 5.5 years, a total of 449 participants (206 men and 243 women) developed a stroke. Four pre-existing comorbidities (hypertension, congenital heart disease, previous stroke, and diabetes) were independently and positively associated with the risk for all types of stroke. The adjusted hazard ratios for participants with only 1 and ≥ 2 pre-existing comorbidities compared with those without pre-existing conditions were 1.96 (95% CI: 1.44, 2.67; P < 0.001) and 2.87 (95% CI; 2.09, 3.94; P < 0.001) for total stroke, respectively. Moreover, male and female participants with a combination of increased age and a higher number of pre-existing comorbidities experienced the greatest risk of stroke.ConclusionsThe number of pre-existing comorbidities was independently associated with an increased risk of stroke. There was a synergic effect between increased age and a higher number of pre-existing comorbidities on stroke occurrence. Our novel findings emphasize the importance and potential application of pre-existing comorbidities as a risk indicator in stroke prevention.
Highlights
Comorbidities, any other coexisting diseases in patients with a particular index disease, are known to increase the mortality of a stroke
The four comorbidities were independently associated with both total and ischemic stroke, while coronary heart disease (CHD) and hypertension had a strong association with non-ischemic stroke
Consistent with a previous report [5], we found that compared with younger participants without comorbidities, those with ≥ 2 pre-existing comorbidities in the elderly group exhibited the highest risk of stroke, suggesting that the accumulation of cardiovascular risk factors significantly increased the occurrence of stroke, especially in elderly groups
Summary
Comorbidities, any other coexisting diseases in patients with a particular index disease, are known to increase the mortality of a stroke. Stroke is ranked as the second leading cause of death and a major cause of disability in the world [1]. This phenomenon is likely caused by the accumulation of risk factors in aging populations [2]. In China, stroke is currently the leading cause of death and one of the main causes of disability [5, 6], and represents a heavy psychological and economic burden to families of patients and society. Studies of comorbidity mainly focus on the burden of disease [9,10,11], rather than pre-existing comorbidities as risk factors of disease, limiting the application of pre-existing comorbidities in public health and clinical treatment
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