Risk-factor profile for the incidence of subarachnoid and intracerebral haemorrhage,cerebral infarction,and unspecified stroke during 21 years' follow-up in men

Abstract

Aims: To study the risk-factor profile for the incidence of non-fatal and fatal stroke among middle-aged men according to the stroke subtypes subarachnoid or intracerebral haemorrhage, cerebral infarction, and unspecified stroke. Methods: The study design is a prospective cohort study. A total of 16,209 men aged 40—49 years resident in Oslo were screened for cardiovascular disease risk factors in 1972—73. Of these, 14,403 men had no cardiovascular symptoms or diseases or diabetes. The incidence of stroke after 21 years of follow-up of all men was extracted from hospital records and linkage to Statistics Norway. Results: A total of 429 non-fatal and 107 fatal stroke events were registered. Case fatality within 28 days (number and percentage of cases) was 51% (41, 7.7%) for subarachnoid haemorrhage, 39% (67, 12.6%) for cerebral haemorrhage, 10% (246, 46.3%) for cerebral infarct, and 19% (177, 33.4%) for unspecified stroke. Risk of stroke (not subarachnoid haemorrhage) increased with the presence of symptoms or a history of cardiovascular disease or diabetes. In multivariate analysis of men without CVD or diabetes, high blood pressure was a risk factor for all subtypes of stroke; furthermore, daily smoking was a risk factor for all subtypes except subarachnoid haemorrhage. Serum cholesterol and glucose concentrations and height (inverse association) were independently associated with cerebral infarction. Smoking was a significantly stronger predictor of fatal than non-fatal events. Conclusions: The risk-factor profile differed according to the underlying subtype of stroke. Cerebral infarction clearly shared with myocardial infarction the classical risk factors, including non-fasting glucose concentration.

Keywords

Case fatality cerebral haemorrhage cerebral infarction fatal incidence non-fatal prospective cohort risk factors stroke subarachnoid haemorrhage

Get full access to this article

View all access options for this article.

References

Tverdal A. , Nelson E. Mortality in Norway by different causes 1951—98. Statens Oslo: Helseundersøkelser, 2001. ISBN 82-91816-04-2.

Ellekjaer H. , Holmen J. , Vatten L. Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly: A 10-year follow-up in Norway. Blood Press 2001;10:156—63.

Njølstad I. , Arnesen E. , Lund-Larsen PG Body height, cardiovascular risk factors, and risk of stroke in middle-aged men and women. A 14-year follow-up of the Finnmark Study. Circulation 1996;94:2877—82.

Leppälä JM , Paunio M. , Virtamo J. , Fogelholm R. , Albanes D. , Taylor PR , Heinonen OP Alcohol consumption and stroke incidence in male smokers. Circulation 1999;14:1209—14.

Harmsen P. , Rosengren A. , Tsipogianni A. , Wilhelmsen L. Risk factors for stroke in middle-aged men in Göteborg, Sweden. Stroke 1990;21:223—9.

Kurth T. , Gaziano JM , Berger K. , Kase CS , Rexrode KM , Cook NR , Buring JE , Manson JE Body mass index and the risk of stroke in men. Arch Intern Med 2002;162:2557—62.

Leren P. , Askevold EN , Foss OP , Frøili A. , Grymyr D. , Helgeland A. , Hjermann I. , Holme I. , Lund-Larsen PG , Norum KR The Oslo Study: Cardiovascular disease in middle-aged and young Oslo men. Acta Med Scand 1975;Suppl. 588:1—38.

L Lund Håheim , I. Holme , I. Hjermann , P. Leren. Risk factors of stroke and mortality. A 12—year follow—up of the Oslo Study. Stroke 1993;24:1484—9.

Rose G. The diagnosis of ischaemic heart pain and intermittent claudication in fields surveys. Bull WHO 1962;27:645.

10.

SPSS version 11.0. Chicago, IL: SPSS Inc.; 1999.

11.

Erikssen G. , Liestøl K. , Bjørnholt JV , Thaulow E. , Erikssen J.

Hypothesis: the recent decline in coronary heart disease mortality — mainly a shift from fatal to non-fatal events?

Scand Cardiovasc J 2000;34:468—74.

12.

L Lund Håheim , S. Tonstad , I. Hjermann , P. Leren , I. Holme. Predictivity of body mass index and other risk factors for fatal coronary heart disease: a 21-year prospective cohort study. Accepted for publication in Scand J Public Health; published online, 2005.

13.

Lund Haheim L , Lund Larsen PG , Sogaard AJ , Holme I. Risk factors associated with body mass index increase after 28 years follow-up in a cohort of men . Submitted for publication.

14.

White PM , Wardlaw JM Unruptured intracranial aneurysms. J Neuroradiol 2003;30:336—50.

15.

Teunissen LL , Rinkel GJ , Algra A. , van Gijn J. Risk factors for subarachnoid hemorrhage: A systematic review. Stroke 1996;27:544—9.

16.

Isaksen J. , Egge A. , Waterloo K. , Romner B. , Ingebrigtsen T. Risk factors for aneurysmal subarachnoid haemorrhage: The Tromsø study. J Neurol Neurosurg Psychiatry 2002;73:185—7.

17.

Yamada S. , Koizumi A. , Iso H. , Wada Y. , Watanabe Y. , Date C. , Yamamoto A. , Kikuchi S. , Inaba Y. , Toyoshima H. , Kondo T. , Tamakoshi A. , Japan Collaborative Cohort Study Group. Risk factors for fatal subarachnoid hemorrhage: The Japan Collaborative Cohort Study. Stroke 2003;34:2781—7.

18.

Sacco RL , Benjamin EJ , Broderick JP , Dyken M. , Easton JD , Feinberg WM , et al. Risk factors. Stroke 1997;28:1507—17.

19.

Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995 ;346:1647—53.

20.

Song Y-M. , Sung D. , Lawlor A. , Smith GS , Shin Y. , Ebrahim S. Blood pressure, haemorrhagic stroke, and ischaemic stroke: The Korean national prospective occupational cohort study. Br Med J 2004;328:324—5.

21.

Lund Håheim L , Holme I. , Hjermann I. , Leren P. Risk of fatal stroke according to blood pressure level: An 18-year follow-up of the Oslo Study . J Hypertension 1995;13:909—13.

22.

Ellekjær EF , Wyller TB , Sverre JM , Holmen J. Lifestyle factors and risk of cerebral infarction . Stroke 1992 ;23:829—34.

23.

Sacco RL , Elkind M. , Boden-AlbalaB. , LinI-Feng , Kargman DE , Hauser WA , SheaWA , PaikMC The protective effect of moderate alcohol consumption on ischemic stroke. JAMA 1999;281:53—60.

24.

Arnesen E. , Forsdahl A. The Tromso heart study: coronary risk factors and their association with living conditions during childhood . J Epidemiol Community Health 1985;39:210—14.

25.

Miura K. , Nakagawa H. , Greenland P.

Height—cardiovascular disease relation: where to go from here?

Am J Epidemiology 2002;155:688—9.

26.

Cui R. , Iso H. , Toyoshima H. , Date C. , Yamamoto A. , Kikuchi S. , Kondo T. , Watanabe Y. , Koizumi A. , Wada Y. , Inaba Y. , Tamakoshi A. , JACC Study Group. Body mass index and mortality from cardiovascular disease among japanese men and women: The JACC Study. Stroke 2005 ;36:1377—82.

27.

Hachinski V. , Graffagnino C. , Beaudry M. , et al. Lipids and stroke: a paradox resolved . Arch Neurol 1996 ;53: 303—8.

28.

Briel M. , Studr M. , Glass TR , Bucher HC Effects of statins on stroke prevention in patients with and without coronary heart disease: A meta-analysis of randomized controlled trials. Am J Med 2004;117:596—606.

29.

Rizos E. , Mikhailidis . Are high density lipoprotein (HDL) and triglyceride levels relevant in stroke prevention? Cardiovasc Res 2001;52:199—207.

30.

Ohlson LO , Svardsudd K. , Welin L. , Eriksson H. , Wilhelmsen L. , Tibblin G. , Larsson B. Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: A 17-year follow-up study of men born in 1913. Diabet Med 1986;3:33—7.

31.

Gill JS , Shipley MJ , Tsementzis SA , Hornby R. , Gill SK , Hitchcock ER , Beevers DG Cigarette smoking: A risk factor for hemorrhagic and nonhemorrhagic stroke . Arch Intern Med 1989;149:2053—7.

32.

Williams JE , Nieto FJ , Sanford CP , Couper DJ , Taylor HA The association between trait anger and incident stroke risk: Atherosclerosis Risk in Communities (ARIC) Study. Stroke 2002;33:13—19.

33.

Lee CD , Folsom AR , Blair SN Physical activity and stroke risk: A meta-analysis . Stroke 2003 ;34:2475—81.

34.

Lee IM , Hennekens CH , Berger K. , Buring JE , Manson JE Exercise and risk of stroke in male physicians . Stroke 1999 ;30:1—6.