Incidence of Stroke and Stroke Subtypes in Malmö, Sweden, 1990–2000

Khan, Farhad Ali; Zia, Elisabet; Janzon, Lars; Engström, Gunnar

doi:10.1161/01.str.0000135761.18954.0b

Cited by 39 publications

(15 citation statements)

References 36 publications

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“…Previous studies have demonstrated that immigrants to Sweden have an increased incidence of CVD [16,17]. However, we can only speculate whether the increased risk of hospitalizations due to HF among immigrants in the present study was related to a reduced or normal ejection fraction.…”

Section: Discussioncontrasting

confidence: 56%

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Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors

Borné

Engström

Essén

et al. 2012

BMC Cardiovasc Disord

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BackgroundStudies from Sweden have reported association between immigrant status and incidence of cardiovascular diseases. The nature of this relationship is unclear. We investigated the relationship between immigrant status and risk of heart failure (HF) hospitalization in a population-based cohort, and to what extent this is mediated by hypertension and life-style risk factors. We also explored whether immigrant status was related to case-fatality after HF.Methods26,559 subjects without history of myocardial infarction (MI), stroke or HF from the community-based Malmö Diet and Cancer (MDC) cohort underwent a baseline examination during 1991-1996. Incidence of HF hospitalizations was monitored during a mean follow-up of 15 years.Results3,129 (11.8%) subjects were born outside Sweden. During follow-up, 764 subjects were hospitalized with HF as primary diagnosis, of whom 166 had an MI before or concurrent with the HF. After adjustment for potential confounding factors, the hazard ratios (HR) for foreign-born were 1.37 (95% CI: 1.08-1.73, p = 0.009) compared to native Swedes, for HF without previous MI. The results were similar in a secondary analysis without censoring at incident MI. There was a significant interaction (p < 0.001) between immigrant status and waist circumference (WC), and the increased HF risk was limited to immigrants with high WC. Although not significant foreign-born tended to have lower one-month and one-year mortality after HF.ConclusionsImmigrant status was associated with long-term risk of HF hospitalization, independently of hypertension and several life-style risk factors. A significant interaction between WC and immigrant status on incident HF was observed.

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Section: Discussioncontrasting

confidence: 56%

“…It has repeatedly been shown that immigrants in Sweden have higher risk of coronary heart disease and stroke compared to Swedish-born subjects [14-17]. In a previous study of the entire population of Malmö, Sweden, we found substantial differences in risk of HF hospitalization among foreign-born subjects [18].…”

Section: Introductionmentioning

confidence: 64%

Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors

Borné

Engström

Essén

et al. 2012

BMC Cardiovasc Disord

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“…However, studies have had divagating findings regarding the influence of SES on the incidence of CVD according to country of birth. One study reported that the increased incidence of myocardial infarction among foreign-born individuals was not influenced by socio-economic differences [9], while other studies have reported some or little effect of SES in relation to the incidence of stroke, CVD and CHD [7,14]. Variations might be a result of differences in the design of the studies, including the definition of incident cases and SES.…”

Section: Discussionmentioning

confidence: 99%

A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?

et al. 2011

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BackgroundThis study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences.MethodsIn this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up.ResultsImmigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES.ConclusionsIn conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.

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“…The endpoints were identified through linkage of the 10-digit personal identification number of each Swedish citizen with four registers: the Swedish Hospital Discharge Register, Swedish Coronary Angiography and Angioplasty Registry (SCAAR), the Stroke Register of Malmö and the Swedish Cause of Death Register. The registers have been previously described and validated for classification of outcomes [18]–[21]. Follow-up for the study extended to June 30, 2009.…”

Section: Methodsmentioning

confidence: 99%

Smoking Modifies the Associated Increased Risk of Future Cardiovascular Disease by Genetic Variation on Chromosome 9p21

et al. 2014

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AimsGenetic predisposition for cardiovascular disease (CVD) is likely to be modified by environmental exposures. We tested if the associated risk of CVD and CVD-mortality by the single nucleotide polymorphism rs4977574 on chromosome 9p21 is modified by life-style factors.Methods and resultsA total of 24944 middle-aged subjects (62% females) from the population-based Malmö-Diet-and-Cancer-Cohort were genotyped. Smoking, education and physical activity-levels were recorded. Subjects were followed for 15 years for incidence of coronary artery disease (CAD; N = 2309), ischemic stroke (N = 1253) and CVD-mortality (N = 1156). Multiplicative interactions between rs4977574 and life-style factors on endpoints were tested in Cox-regression-models. We observed an interaction between rs4977574 and smoking on incident CAD (P = 0.035) and CVD-mortality (P = 0.012). The hazard ratios (HR) per risk allele of rs4977574 were highest in never smokers (N = 9642) for CAD (HR = 1.26; 95% CI 1.13–1.40; P<0.001) and for CVD-mortality (HR = 1.40; 95% CI 1.20–1.63; P<0.001), whereas the risk increase by rs4977574 was attenuated in current smokers (N = 7000) for both CAD (HR = 1.05; 95%CI 0.95–1.16; P = 0.326) and CVD-mortality (HR = 1.08; 95%CI 0.94–1.23; P = 0.270). A meta-analysis supported the finding that the associated increased risk of CAD by the risk-allele was attenuated in smokers. Neither education nor physical activity-levels modified the associated risk of CAD, ischemic stroke and CVD mortality conferred by rs4977574.ConclusionSmoking may modify the associated risk of CAD and CVD-mortality conferred by genetic variation on chromosome 9p21. Whether the observed attenuation of the genetic risk reflects a pathophysiological mechanism or is a result of smoking being such a strong risk-factor that it may eliminate the associated genetic effect, requires further investigation.

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Incidence of Stroke and Stroke Subtypes in Malmö, Sweden, 1990–2000

Cited by 39 publications

References 36 publications

Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors

Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors

A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?

Smoking Modifies the Associated Increased Risk of Future Cardiovascular Disease by Genetic Variation on Chromosome 9p21

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