Comparison of risk factors for ischemic stroke and coronary events in a population-based cohort

Iram Faqir Muhammad,Margaretha Persson,Gunnar Engström,Yan Borné,Linda Johnson,Martin Söderholm,Suneela Zaigham,Olle Melander

doi:10.1186/s12872-021-02344-4

Iram Faqir Muhammad, Margaretha Persson + Show 6 more

Open Access

https://doi.org/10.1186/s12872-021-02344-4

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Abstract

BackgroundAlthough coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes.MethodTraditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes.ResultsMost cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE.ConclusionCE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.

Highlights

Cardiovascular diseases (CVD) are one of the leading causes of morbidity and mortality in the world [1]
Most cardiovascular risk factors were associated both with incident coronary events (CE) and ischemic stroke
Current smoking, apolipoprotein B (ApoB), low Apolipoprotein A1 (ApoA1), male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke

Summary

Introduction

Cardiovascular diseases (CVD) are one of the leading causes of morbidity and mortality in the world [1]. Based on established risk markers, risk prediction models for CVD have been developed [8]. Controversies exist and risk factors have shown differences with respect to the prediction of CE and stroke [9] 10. Breaking down the composite endpoint of CVD into CE and ischemic stroke may help in assessing these risks separately and provide additional information to improve predictability. Establishing whether well-known risk factors contribute in a similar manner towards the risk of CE and ischemic stroke is essential for understanding underlying pathology and could be used to find hypotheses for developing interventions. Coronary events (CE) and ischemic stroke share many risk factors, there are some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes

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