Risk Of Stroke In Men Research Articles

Application of the China-PAR stroke risk equations in a rural northern Chinese population

To validate five-year risk prediction models for stroke in a contemporary rural Northern Chinese population. Totally 6 483 rural adults aged 40 to 79 years without cardiovascular diseases were enrolled at baseline between June and August 2010, and followed up through January 2017. Expected prediction risk using the China-PAR (prediction for atherosclerotic cardiovascular disease risk in China) stroke risk equations were compared with the new Framingham stroke risk profile (FSRP). The recalibrated models were applied by adjusting the five-year baseline survival rate and the mean score to our rural northern Chinese population, while keeping other coefficient parameters the same as the original models. Kaplan-Meier analysis was used to obtain the observed event (nonfatal or fatal stroke) rate for the five years, and the expected-observed ratios were calculated to evaluate overestimation or underestimation in the cohort. The models were assessed by discrimination C statistic, calibration χ2, and calibration charts and plots for illustration as well. Over an average of (5.83 ± 1.14) years of the follow-up in this validation cohort with 6 483 rural Chinese participants, 438 subjects deve-loped a first stroke event. Recalibrated China-PAR stroke risk equations and FSRP well-performed for predicting five-year stroke risk in men, and had C statistics of 0.709 (95%CI, 0.675 - 0.743) and 0.721 (95%CI, 0.688 - 0.754), with calibration χ2 values being 5.7 (P = 0.770) and 13.6 (P = 0.137), respectively. However, both China-PAR and FSRP overestimated stroke events by 11.6% and 30.0% in women, and had C statistics of 0.713 (95%CI, 0.684-0.743) and 0.710 (95%CI, 0.679-0.740), respectively. Calibration χ2 values in women were 12.5 (P = 0.188) for China-PAR and 24.0 (P = 0.004) for FSRP. In addition, the calibration charts and plots illustrated good agreement between the observations and the predictions only in the China-PAR stroke risk equations, especially for men. In this validation cohort of rural northern Chinese adults, the China-PAR models had better performance of five-year stroke risk prediction than the FSRP, indicating that recalibrated China-PAR stroke risk equations might be appropriate tools for risk assessment and primary prevention of stroke in China.

Non-High-Density Lipoprotein Cholesterol and Risk of Stroke Subtypes and Coronary Heart Disease: The Japan Public Health Center-Based Prospective (JPHC) Study

Aim: A positive association between non-high-density lipoprotein cholesterol (non-HDL-C) and coronary heart disease (CHD) has been established; however, associations between non-HDL-C and stroke subtypes have not been determined.Methods: We conducted a prospective study of 30,554 individuals aged 40–69 yrs with no history of cardiovascular disease (CVD) in Japan. Sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of stroke subtypes and CHD were estimated according to quintiles of non-HDL-C, using Cox proportional hazard models adjusted for other established risk factors.Results: We identified 1,705 stroke and 296 CHD events over a median 15 yrs of follow-up. The fractional polynomials analysis revealed a U-shaped association between non-HDL-C and stroke risk in men. When analyzed for stroke subtypes, the data revealed an inverse relationship between non-HDL-C and intracerebral hemorrhage (ICH), primarily with lobar ICH, and a positive association between non-HDL-C and large-artery occlusive infarction in men [adjusted HR 0.55 (95% CI, 0.35–0.87) and 2.05 (95% CI, 1.07–3.93) for the highest and lowest quintile of non-HDL-C, respectively]. The lowest risk of ICH in women was observed in the fourth quintile, and the lowest risk of embolic infarction was observed in the third quintile. In contrast, non-HDL-C was positively associated with CHD in both sexes.Conclusions: In Japanese men, lower non-HDL-C levels were associated with a decreased risk of large-artery occlusive infarction and an increased risk of ICH, particularly lobar ICH.

Asthma, asthma control and risk of ischemic stroke: The HUNT study

BackgroundAsthma, a chronic inflammatory airway disease, shares common pathophysiological mechanisms with ischemic stroke. The aim of the study is to assess the association between asthma, levels of asthma control and ischemic stroke risk in men and women and by smoking habits. MethodsThis prospective population-based cohort study utilized data on 58 712 adults from HUNT Study in Norway free from stroke. Self-reported asthma was categorized as ever asthma, non-active asthma and active asthma (i.e., being on asthma medication within 12 months of the baseline). Asthma control was defined according to the Global Initiative for Asthma questionnaire and was categorized into controlled and not controlled asthma. Stroke was ascertained by linking HUNT data with Nord-Trøndelag hospital records and the Norwegian Patient Registry. ResultsDuring a mean follow-up of 17.3 ± 5.3 years, 2619 participants (4.5%) had a first stroke. Not controlled asthma was associated with a modest increased risk of stroke (adjusted HR 1.34, 95%CI 1.03–1.73). Subgroup analyses revealed that the respective association was stronger among those with history of smoking (HR 1.48, 95%CI 1.10–2.00) and males (HR 1.55, 95%CI 1.12–2.16) while absent in non-smokers (HR 1.02, 95%CI 0.61–1.70) and females (HR 1.05, 95%CI 0.69–1.60). Likewise, active asthma was associated with similar increased stroke risk among smokers and males and absent in non-smokers and females. ConclusionsSymptomatic and active asthma was associated with a modest increased relative risk for ischemic stroke in smokers and males. Future studies should clarify the difference in risks and mechanisms between different phenotypes of asthma.

Trajectories of Haemoglobin and incident stroke risk: a longitudinal cohort study

BackgroundStudies have demonstrated that high or low haemoglobin increases the risk of stroke. Previous studies, however, performed only a limited number of haemoglobin measurements, while there are dynamic haemoglobin changes over the course of a lifetime. This longitudinal cohort study aimed to classify the long-term trajectory of haemoglobin and examine its association with stroke incidence.MethodsThe cohort consisted of 11,431 participants (6549 men) aged 20 to 50 years whose haemoglobin was repeatedly measured 3–9 times during 2004–2015. A latent class growth mixture model (LCGMM) was used to classify the long-term trajectory of haemoglobin concentrations, and hazard ratios (HRs) and 95% confidence intervals (95% CI) according to the Cox proportional hazard model were used to investigate the association of haemoglobin trajectory types with the risk of stroke.ResultsThree distinct trajectory types, high-stable (n = 5395), normal-stable (n = 5310), and decreasing (n = 726), were identified, with stroke incidence rates of 2.7, 1.9 and 3.2 per 1000 person-years, respectively. Compared to the normal-stable group, after adjusting for the baseline covariates, the decreasing group had a 2.94-fold (95% CI 1.22 to 7.06) increased risk of developing stroke. Strong evidence was observed in men, with an HR (95% CI) of 4.12 (1.50, 11.28), but not in women (HR = 1.66, 95% CI 0.34, 8.19). Individuals in the high-stable group had increased values of baseline covariates, but the adjusted HR (95% CI), at 1.23 (0.77, 1.97), was not significant for the study cohort or for men and women separately.ConclusionsThis study revealed that a decreasing haemoglobin trajectory was associated with an increased risk of stroke in men. These findings suggest that long-term decreasing haemoglobin levels might increase the risk of stroke.

Leisure Time Physical Activity Reduces the Risk for Stroke in Adults: A Reanalysis of a Meta-Analysis Using the Inverse-Heterogeneity Model.

Objective Apply more robust and additional analyses to a previous meta-analysis that reported statistically significant associations between leisure time physical activity (LTPA) and stroke. Methods A reanalysis of a previous meta-analysis that included nine prospective cohort studies representing 269,594 men and women 25-84 years of age and in which the association between LTPA and incident stroke was examined. Follow-up periods ranged from 7.7 to 32.0 years. Relative risks (RR) from each study were pooled using the inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I2, and small-study effects using Doi plots and the LFK index. Influence and cumulative meta-analysis were also conducted. Results Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95) and a trend in women (RR = 0.88, 95% CI = 0.78 to 1.0). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86) and women (RR = 0.78, 95% CI = 0.66 to 0.92). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005. Conclusions Leisure time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.

Cumulative alcohol consumption and stroke risk in men.

Views on the relationship between alcohol consumption and stroke risk remain controversial. Moreover, data on cumulative alcohol intake are limited. We examined the potential impact of cumulative alcohol consumption on the risk of total stroke and its subtypes in men. This prospective study included 23,433 men from the Kailuan Study. Cumulative alcohol consumption was taken as the primary exposure by calculating self-reported alcohol consumption from three consecutive examinations (in 2006, 2008, and 2010). The first occurrence of stroke was confirmed by reviewing medical records from 2010 to 2016. We used Cox proportional hazards regression to analyze the data. During the 5.9 ± 0.8years of follow-up, 678 total strokes were identified, including 595 ischemic stroke (IS), 90 intracerebral hemorrhage and 19 subarachnoid hemorrhage cases. The adjusted hazard ratios (95% confidence intervals) of total stroke for light, moderate and heavy cumulative alcohol consumption were 1.23 (1.01-1.51), 1.49 (1.13-1.97), and 1.50 (1.21-1.86), respectively, compared with those of nondrinkers. The results were similar for IS. Cumulative alcohol consumption was not associated with intracerebral hemorrhage risk (hazard ratio 1.46; 95% confidence interval, 0.74-2.08). Cumulative alcohol consumption is an independent risk factor of total stroke and IS in men in a community-based cohort. Even light alcohol intake increases the risk of total stroke and IS.

Abstract WP512: Leisure-time Physical Activity Reduces the Risk for Stroke in Adults: A Meta-Analysis of Prospective Cohort Studies

Introduction: The magnitude of the association between physical activity and stroke in adults has not been firmly established. Hypothesis: Physical activity is associated with a reduction in the risk of stroke among adults. Methods: Data from a previous meta-analysis of nine prospective cohort studies representing 269,594 men and women 25-84 years of age that examined the association between leisure-time physical activity (LTPA) and incident stroke was examined using recently developed and more robust methods than those previously employed. Follow-up periods ranged from 7.7-32.0 years. Relative risks (RR) from each study were pooled using the more robust inverse-heterogeneity model. Heterogeneity was examined using the Q statistic, inconsistency using I 2 , and small-study effects using funnel and Doi plots. Influence and cumulative meta-analysis were also conducted. A two-tailed alpha level <0.05 was considered statistically significant. Results: Using low LTPA as the reference, moderate LTPA was associated with a statistically significant reduction in the risk for stroke in men (RR = 0.79, 95% CI = 0.65 to 0.95, p = 0.01) and a trend for the same in women (RR = 0.88, 95% CI = 0.78 to 1.0, p = 0.05). High LTPA was associated with a statistically significant reduction in the risk for stroke in both men (RR = 0.72, 95% CI = 0.60 to 0.86, p <0.001) and women (RR = 0.78, 95% CI = 0.66 to 0.92, p = 0.004). No statistically significant heterogeneity was observed and inconsistency was low. However, potential small-study effects were observed. With each study deleted once, results remained statistically significant. Cumulative meta-analysis demonstrated stability in results since at least 2005. Conclusions: Leisure-time physical activity is associated with a reduced risk of stroke in both men and women. However, the small-study effects observed suggest the possibility that results may be exaggerated.

Способ прогнозирования риска развития инсульта у мужчин, работающих в условиях воздействия общей вибрации

Способ прогнозирования риска развития инсульта у мужчин, работающих в условиях воздействия общей вибрации

Is serum uric acid a predictive factor for stroke in men with hypertriglyceridemia?

This study investigated the association between serum uric acid (sUA) and stroke risk in men with hypertriglyceridemia. Between 2002 and 2012, male patients with pure hypertriglyceridemia and a triglyceride (TG) level ≥ 150 mg/dL were enrolled. Eligible patients were categorized into two groups according to their sUA levels (≥ and < 8 mg/dL). Clinical characteristics and comorbidities that are risk factors for stroke were recorded and compared between the groups. A total of 265 male patients (95 with sUA ≥ 8 mg/dL and 170 with sUA < 8 mg/dL) were enrolled. The incidence of ischemic type of stroke was significantly higher in patients with sUA ≥ 8 mg/dL (p = 0.038), particularly in the age range of 45-65 years. Multivariate Cox proportional analyses confirmed that age (p = 0.003) and UA (p = 0.019) were major predictive factors for stroke free (ischemic type of stroke) survival. Among men with hypertriglyceridemia, the incidence rate of ischemic type of stroke significantly increased with sUA levels ≥ 8 mg/dL, particularly in men aged 45 to 65 years. Hyperuricemia is considered a potential predictive factor for ischemic type of stroke and may indicate the need for preventive management in patients with hypertriglyceridemia (Tab. 3, Fig. 1, Ref. 28).

Psychological Distress and Risk of Myocardial Infarction and Stroke in the 45 and Up Study

Background The interplay between mental and physical health remains poorly understood. We investigated whether psychological distress is associated with risk of myocardial infarction (MI) and stroke in a population-based prospective study. Methods and Results We included participants without prior stroke/MI from the New South Wales 45 and Up Study. We categorized baseline psychological distress as low, medium, and high/very high on the 10-item Kessler Psychological Distress scale and identified stroke and MI through linkage to hospital admission and mortality records. We obtained sex and age-stratified adjusted and unadjusted hazard ratios for the association between psychological distress and MI and stroke. We investigated for interaction between psychological distress and each of age and sex. Among 221 677 participants, 16.2% and 7.3% had moderate and high/very high psychological distress at recruitment, respectively. During 4.7 (±0.98 SD) years of follow-up, 4573 MIs and 2421 strokes occurred. Absolute risk of MI and stroke increased with increasing psychological distress level. In men aged 45 to 79 years, high/very high versus low psychological distress was associated with a 30% increased risk of MI (fully adjusted hazard ratios, 1.30; 95% CI, 1.12-1.51), with weaker estimates in those aged ≥80 years. Among women, high/very high psychological distress was associated with an 18% increased risk of MI (adjusted hazard ratio, 1.18; 95% CI, 0.99-1.42) with similar findings across age groups. In the age group of participants aged 45 to 79 years, high/very high psychological distress and male sex had a supra-additive effect on MI risk. Similar estimates were observed for stroke, with high/very high psychological distress associated with a 24% and 44% increased stroke risk in men and women, respectively, with no evidence of interaction with age or sex. Conclusions Psychological distress has a strong, dose-dependent, positive association with MI and stroke in men and women, despite adjustment for a wide range of confounders.

Education, sex and risk of stroke: a prospective cohort study in New South Wales, Australia

ObjectiveTo determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.DesignProspective cohort study.SettingPopulation based, New...

Sex-related differences in abdominal obesity impact on ischemic stroke risk.

The objective of our study was to evaluate sex differences in the impact of weight and abdominal obesity on the risk of ischemic stroke. We included 388 patients with ischemic stroke (aged <75 years) assessed consecutively in our hospital and 732 controls matched by age and sex. Vascular risk factors and anthropometric data (waist circumference, weight and height) were recorded. The impact of three anthropometric variables [body mass index (BMI), waist circumference and waist to height ratio] on ischemic stroke risk was calculated. These variables were divided into quartiles for a comprehensive comparison between cases and controls, stratified by sex and adjusted in logistic regression by age and vascular risk factors. Further logistic regression using dummy variables was performed to evaluate the association between BMI-adjusted abdominal obesity and stroke risk. Increased BMI was not associated with increased stroke risk overall or in women, but was a protective factor in men [P = 0.03; odds ratio (OR), 0.59 (0.37-0.94)]. Abdominal obesity was a risk factor for stroke in women, in both waist circumference [P < 0.001; OR, 5.79 (3.10-10.85)] and waist to height ratio [P < 0.001; OR, 3.61 (1.99-6.54)] analyses, but was not significant in men. When considered independently of BMI, abdominal obesity was a risk factor in both sexes, but the strength of the association was significantly higher in women. Increased BMI was related to a lower risk of stroke in men. Abdominal obesity was associated with ischemic stroke in women. The impact of abdominal obesity on stroke risk differs by sex.

Fish consumption and risk of stroke: a second prospective case-control study from northern Sweden.

BackgroundFish consumption has been concluded to be associated with decreased risk of stroke in several reviews. However, among men, but not women, an increased risk of stroke was previously found at high fish consumption (>3 meals/week) in northern Sweden. This study investigates if previous results on elevated stroke risk with high fish consumption in men in northern Sweden can be confirmed in a larger study with new cases in the same population.MethodsA prospective nested case-control study was performed within the population-based Northern Sweden Health and Disease Study cohort. Information on fish consumption, other lifestyle and medical data was collected at baseline. Incident stroke cases (1987–2007, n = 735) were identified and 2698 controls matched for gender, age, year of baseline and geographical region.ResultsThere were no associations between total fish or fatty fish consumption and stroke risk; thus the previous finding of increased risk of stroke with high fish consumption in men could not be repeated. High intake of lean fish (>twice/week compared to < once/month) was associated with increased stroke risk in men [OR 1.80 (95% CI 1.00, 3.21), but not in women [OR 0.50 (95% CI 0.24, 1.10)]. The association was driven by men living alone.ConclusionsThe previous association between high total fish consumption and risk of stroke in men could not be repeated. The increased risk found in men with high intake of lean fish may be due to chance or confounding specific for this group.Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-016-0216-3) contains supplementary material, which is available to authorized users.

Associations of serum n-3 and n-6 PUFA and hair mercury with the risk of incident stroke in men: the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD).

PUFA have been associated with lower risk of CVD, but less is known about their association with stroke risk. Fish, a major source of n-3 PUFA, may also contain methylmercury, which has been associated with higher risk of CVD and attenuation of the benefits of long-chain n-3 PUFA. We investigated the associations of serum n-3 and n-6 PUFA and hair Hg with risk of stroke in men. A total of 1828 men from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study, aged 42-60 years and free of CVD at baseline in 1984-1989 were studied. Cox regression models were used for the analyses. During the mean follow-up of 21·2 years, 202 stroke cases occurred, of which 153 were ischaemic strokes. After adjustment for age and examination year, the only statistically significant association among the n-3 and n-6 PUFA was observed between the n-3 PUFA α-linolenic acid and risk of haemorrhagic stroke (hazard ratio in the highest v. the lowest quartile 0·33; 95 % CI 0·13, 0·86; P trend=0·03). However, further adjustments attenuated the association to statistically non-significant. Hair Hg was not associated with stroke risk, but among those with hair Hg above the median level, higher serum long-chain n-3 PUFA concentrations were associated with a higher risk of ischaemic stroke. In our cohort of men, serum n-3 or n-6 PUFA or hair Hg were not associated with stroke risk; however, the interaction between Hg and long-chain n-3 PUFA with regard to ischaemic stroke risk warrants further investigation.

Unprocessed red meat and processed meat consumption and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC).

High intakes of unprocessed red or processed meat may increase the risk of stroke. We aimed to examine the association between unprocessed red meat, processed meat and total red meat consumption and risk of total stroke and ischaemic stroke. Cox proportional hazards regression analyses were conducted based on the data for 41,020 men and women aged 29-69 years at baseline. During a mean follow-up of 13.8 years, 674 incident cases of stroke (531 ischaemic strokes, 79 haemorrhagic strokes, 42 subarachnoid haemorrhages and 22 mixed or unspecified events) were identified. After multiple adjustment, unprocessed red meat, processed meat and total red meat consumption were not correlated with incidence of total stroke or ischaemic stroke in either men or women. The hazard ratios (HRs) for unprocessed red meat and processed meat and risk of total stroke comparing the highest with the lowest quintiles were, respectively, 0.81 (95% confidence interval (CI) 0.54-1.21; P-trend=0.15) and 0.92 (95% CI 0.64-1.32; P-trend=0.82) in men and 1.21 (95% CI 0.79-1.85; P-trend=0.10) and 0.81 (95% CI 0.51-1.27; P-trend=0.17) in women. The HRs for unprocessed red meat and processed meat and risk of ischaemic stroke were, respectively, 0.80 (95% CI 0.51-1.25; P-trend=0.51) and 0.86 (95% CI 0.57-1.29; P-trend=0.77) in men and 1.24 (95% CI 0.74-2.05; P-trend=0.13) and 0.82 (95% CI 0.47-1.42; P-trend=0.31) in women. In the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, unprocessed red meat and processed meat consumption were not associated with risk of stroke in men or women.

No association between fish consumption and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain): a 13·8-year follow-up study.

To prospectively assess the associations between lean fish, fatty fish and total fish intakes and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Fish intake was estimated from a validated dietary questionnaire. Cox proportional hazards regression models were used to assess the association between the intakes of lean fish, fatty fish and total fish and stroke risk. Models were run separately for men and women. Five Spanish regions (Asturias, San Sebastian, Navarra, Granada and Murcia). Individuals (n 41 020; 15 490 men and 25 530 women) aged 20-69 years, recruited from 1992 to 1996 and followed-up until December 2008 (December 2006 in the case of Asturias). Only participants with definite incident stroke were considered as cases. During a mean follow-up of 13·8 years, 674 strokes were identified and subsequently validated by record linkage with hospital discharge databases, primary-care records and regional mortality registries, comprising 531 ischaemic, seventy-nine haemorrhagic, forty-two subarachnoid and twenty-two unspecific strokes. After multiple adjustments, no significant associations were observed between lean fish, fatty fish and total fish consumption and the risk of stroke in men or women. In men, results revealed a non-significant trend towards an inverse association between lean fish (hazard ratio=0·84; 95 % CI 0·55, 1·29, P trend=0·06) and total fish consumption (hazard ratio=0·77; 95 % CI 0·51, 1·16, P trend=0·06) and risk of total stroke. In the EPIC-Spain cohort, no association was found between lean fish, fatty fish and total fish consumption and risk of stroke.

Primary prevention of stroke by a healthy lifestyle in a high-risk group.

To examine the impact of a healthy lifestyle on stroke risk in men at higher risk of stroke because of other cardiovascular diseases or conditions. Our study population comprised 11,450 men in the Cohort of Swedish Men who had a history of hypertension, high cholesterol levels, diabetes, heart failure, or atrial fibrillation. Participants had completed a questionnaire about diet and lifestyle and were free from stroke and ischemic heart disease at baseline (January 1, 1998). We defined a healthy lifestyle as a low-risk diet (≥5 servings/d of fruits and vegetables and <30 g/d of processed meat), not smoking, ≥150 min/wk of physical activity, body mass index of 18.5 to 25 kg/m(2), and low to moderate alcohol consumption (>0 to ≤30 g/d). Ascertainment of stroke cases was accomplished through linkage with the National Inpatient Register and the Swedish Cause of Death Register. During a mean follow-up of 9.8 years, we ascertained 1,062 incident stroke cases. The risk of total stroke and stroke types decreased with increasing number of healthy lifestyle factors. The multivariable relative risk of total stroke for men who achieved all 5 healthy lifestyle factors compared with men who achieved 0 or 1 factor was 0.28 (95% confidence interval 0.14-0.55). The corresponding relative risks (95% confidence interval) were 0.31 (0.15-0.66) for ischemic stroke and 0.32 (0.04-2.51) for hemorrhagic stroke. A healthy lifestyle is associated with a substantially reduced risk of stroke in men at higher risk of stroke.

Physical Activity in Primary Stroke Prevention

Stroke is a preventable disease. Well-documented, modifiable risk factors for stroke include hypertension, diabetes mellitus, dyslipidemia, obesity and body fat distribution, cigarette smoking, atrial fibrillation, heart disease, and physical inactivity.1,2 There is a wealth of information supporting physical activity (PA) as an important component of primary stroke prevention strategies. The proposed mechanism is that PA improves vascular function and stroke risk factors.3 The well-known health benefits of regular PA include reducing the risk of hypertension, type 2 diabetes mellitus, depression, and obesity, as well as control of these risk factors.4–7 Although data from multiple clinical trials support a reduction in stroke risk factors with PA,4,8–11 there are no clinical trials data demonstrating the efficacy of PA in reducing stroke incidence, partially because of the long follow-up required to achieve a sufficient number of events. The next best evidence comes from nonrandomized cohort studies where the consistency of results strongly supports the benefit of PA in primary stroke prevention (Class I, Level of Evidence B).1 The purpose of this review is to summarize the terminology and measurement of PA, synthesize the results of studies of PA and stroke risk in men and women, and describe how PA can ameliorate the effects of stroke risk factors, such as diabetes mellitus and hypertension. The challenges with PA research will also be discussed, as well as recommendations for future research. PA is a complex behavior that can incorporate different elements, including occupational or leisure time PA, commuting, sport, walking, and exercise training. The accepted definition of PA used by most researchers is “any bodily movement produced by skeletal muscles that results in energy expenditure” (p. 126).12 This differs from exercise, a subset of PA defined as “PA that is planned, …

N-terminal pro-B-type natriuretic peptide and the risk of stroke and transient ischaemic attack: the Rotterdam Study.

Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor of heart disease. It has also been related to stroke, but its association with transient ischaemic attacks (TIAs) is unclear. Moreover, it is unknown how clinical heart disease influences this relation. Within the prospective population-based Rotterdam Study, the association of NT-proBNP with stroke and TIA was examined and the role of heart disease on this association was investigated. NT-proBNP was measured in 1997-2001 in 5611 participants (mean age 68.7years; 57.7% women) without a history of stroke, TIA or heart failure. Follow-up for stroke and TIA finished in 2012. Models were adjusted for age and cardiovascular risk factors, and were stratified by sex. During 22058 person-years 195 men suffered a stroke and 118 a TIA. During 31825 person-years 230 women suffered a stroke and 187 a TIA. Higher NT-proBNP was associated with a higher risk of stroke in men [hazard ratio (HR) per SD increase 1.50; 95% confidence interval (CI) 1.29-1.76] and in women (HR 1.24; 95% CI 1.05-1.46). Associations with TIA were only present in women (HR 1.51; 95% CI 1.26-1.82) but not in men (HR 1.02; 95% CI 0.83-1.26). Excluding persons with a history of clinical coronary heart disease, heart failure or atrial fibrillation and censoring for clinical heart disease during follow-up did not change the associations. Higher NT-proBNP is associated with incident stroke in men and women and with incident TIA only in women. These associations are independent of clinical heart disease preceding cerebrovascular disease.

Risk Factors Assessed in Adolescence and the Later Risk of Stroke in Men: A 33-Year Follow-Up Study

Background: Stroke is a common cause of death, and a leading contributor to long-term disability. The cost associated with the disease is great. Several modifiable risk factors for stroke have been found in older cohorts; however, no study to date has investigated the effects of these risk factors from late adolescence. Methods: The study cohort comprised 811,579 Swedish men (mean age, 18 years) that participated in the mandatory military conscription service in Sweden between 1969 and 1986. Some risk factors for stroke, such as body mass index, systolic and diastolic blood pressure, and cognitive function, were assessed at conscription. Aerobic fitness was also assessed at conscription, using a braked ergometer cycle test. Other risk factors for stroke, including stroke in subjects' parents, and socioeconomic factors including highest achieved level of education and annual income 15 years after conscription, were collected through national register linkage using the personal identification number. Stroke diagnosis among the study participants was tracked in the National Hospital Discharge Patient Register. Results: During a median follow-up period of 33 years 6,180 ischemic strokes and 2,104 hemorrhagic strokes were diagnosed in the cohort at a mean age of 47.9 years. Strong independent risk factors (all p <1.0 × 10−⁶) for ischemic stroke included low aerobic fitness (hazard ratio [HR], 0.84 per standard deviation [SD] increase), high BMI (HR, 1.15 per SD increase), diabetes (HR, 2.85), alcohol intoxication (HR, 1.93), low annual income (HR, 0.85 per SD decrease), and stroke in the mother (HR, 1.31). Similar risk factors were found for hemorrhagic stroke including low aerobic fitness (HR, 0.82 per SD increase), high BMI (HR, 1.18 per SD increase) alcohol intoxication (HR, 2.92), diabetes (HR, 2.06), and low annual income (HR, 0.75). The population attributable risks associated with all evaluated risk factors were 69% for ischemic stroke and 88% for hemorrhagic stroke (p < 0.001 for both). Conclusions: In the present study we have shown that several known risk factors for stroke are present already in late adolescence, and that they are independent of each other. The strongest risk factors were low physical fitness, high BMI, diabetes, low annual income and a maternal history of stroke. Several of the aforementioned risk factors are potentially modifiable.