Relative Risks for Stroke by Age, Sex, and Population Based on Follow-Up of 18 European Populations in the MORGAM Project

W orldwide, cerebrovascular disease is the second leading cause of death not only in high-income but also in lowincome countries. Patients with type 1 diabetes mellitus have a markedly increased risk of stroke compared with nondiabetic subjects, 1 and it is of note that these patients are at a high risk of stroke 10 to 15 years earlier than nondiabetic subjects. 2 Age, hypertension, atrial fibrillation, smoking, and diabetes mellitus are well-known risk factors for stroke in the general population. [2][3][4][5] In patients with type 2 diabetes mellitus, similar risk factors have been observed. 6 Furthermore, the metabolic syndrome and its components have also been shown to increase the risk of stroke, especially in patients with type 2 diabetes mellitus. Although the risk factors for stroke in patients with type 2 diabetes mellitus have been assessed in several studies, few studies on the risk factors for stroke and stroke subtypes in patients with type 1 diabetes mellitus exist. No sex difference has been observed for the risk of stroke in type 1 diabetes mellitus, which is in contrast to the general population in which premenopausal women are protected from cardiovascular disease and stroke.1,2 Stroke is usually divided into 2 subgroups: ischemic stroke and hemorrhagic stroke. Ischemic stroke can be further subgrouped into lacunar and nonlacunar infarction, whereas hemorrhagic stroke includes intracerebral and subarachnoid hemorrhage. We have earlier shown that both the severity of diabetic nephropathy (DN) and the presence of severe diabetic retinopathy (SDR) increase the risk of any stroke, ischemic stroke, lacunar infarction, and hemorrhagic stroke. 8 However, comprehensive studies on independent risk factors for each subtype of stroke are still missing.Therefore, we aimed to study the independent risk factors for stroke, and also for the subtypes ischemic stroke, lacunar Background and Purpose-Despite the fact that patients with type 1 diabetes mellitus have a markedly increased risk of experiencing a stroke, independent risk factors for stroke and its subtypes in these patients have remained unclear. Methods-A total of 4083 patients with type 1 diabetes mellitus from the Finnish Diabetic Nephropathy (FinnDiane) Study, without a history of stroke at baseline, were included. Strokes were classified based on medical files and brain imaging. At baseline, mean age was 37.4±11.8 years, duration of diabetes mellitus was 20.0 (11.0-30.0) years, and 51% were men. During 9.0±2.7 years (36 680 patient-years) of follow-up, 105 patients experienced an ischemic stroke and 44 a hemorrhagic stroke. Cox proportional hazards analyses were performed to determine independent risk factors. Results-Independent risk factors for ischemic stroke were duration of diabetes mellitus, presence of diabetic nephropathy, higher hemoglobin A 1c , higher systolic blood pressure, insulin resistance, and history of smoking, whereas sex, lipids, high-sensitivity C-reactive protein, and the metabolic syndrome were not associated with an incre...

supporting

confidence: 57%

Different Risk Factor Profiles for Ischemic and Hemorrhagic Stroke in Type 1 Diabetes Mellitus

Hägg

Thorn

Forsblom

et al. 2014

“…After full-text evaluation, 16 articles were selected that provided information from 34 cohorts on sex differences in the association between smoking and stroke in the general population (Table). 5,6,15,16,[25][26][27][28][29][30][31][32][33][34][35] These data were extended with data from ARIC, 18 NHANES III, 19 APCSC, 20 and SHHEC, 21 adding a further 47 cohorts. Baseline characteristics of all 81 cohorts included in this study are described in the Table. Overall, data on 3 980 359 individuals were available, in whom ≥42 401 fatal and nonfatal strokes were documented (1 study, including 56 167 individuals, did not report the number of stroke events).…”

Section: Resultsmentioning

confidence: 99%

Smoking as a Risk Factor for Stroke in Women Compared With Men

Peters

Huxley

Woodward

2013

193

Thus, given the unequivocal link between smoking and stroke, Background and Purpose-It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. Methods-PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. Results-Data

“…After full-text evaluation, 20 articles were selected that provided information from 77 cohorts on sex differences in the association between SBP and stroke or IHD (Tables 1 and 2). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Individual participant data from ARIC, 11 NHANES III, 10 APCSC, 13 and SHHEC 12 were subsequently added to these published results, giving a total of 24 studies comprising 124 prospective cohorts (Table 1). Overall, data from 1197 472 individuals (44% women) in …”

Section: Resultsmentioning

confidence: 99%

Comparison of the Sex-Specific Associations Between Systolic Blood Pressure and the Risk of Cardiovascular Disease

Peters

Huxley

Woodward

2013

118

In 2000, more than a quarter of the world's adult population, totaling nearly 1 billion people, were estimated to have hypertension-a figure that is projected to increase to 29% (1.5 billion) in 2025. 5 Worldwide, it is the leading risk factor for cardiovascular disease (CVD) and accounts for >13% (7 million) of deaths each year, as well as a substantial amount of disability. 1These estimates of disease burden are based on the assumption that the association between systolic blood pressure (SBP) and CVD does not appreciably differ between women and men. But this premise may not be wholly correct because results from previous large-scale pooling studies have been inconsistent. [6][7][8][9] Data from the Prospective Studies Collaboration (PSC), an individual participant data meta-analysis of 1 million individuals, showed slightly more extreme hazards for men compared with women for SBP-related stroke risk (particularly in younger age groups). 6 In contrast, in the Asia Pacific Cohort Studies Collaboration (APCSC), involving more than half a million individuals, no evidence of a sex difference at any age for the association between SBP and fatal stroke was found, 9 a finding that is in agreement with data from the extensive INTERSTROKE case-control study.7 For ischemic heart disease (IHD), results from the PSC showed slightly more extreme hazards associated with increases in SBP in women than in men (although no formal comparison was performed), particularly among younger age groups. 6 Similarly, a more extreme odds ratio for acute myocardial infarction associated with hypertension in women compared with men was reported in the INTERHEART case-control study. 8 In contrast, there was no sex difference with total IHD, fatal IHD, or nonfatal myocardial infarction in APCSC. 9 To date, there has been no systematic comparison of sex differences in the SBP-CVD relation. Given the possible implications that any sex difference might have on currentBackground and Purpose-Conflicting results have been reported on whether the association between increments in systolic blood pressure (SBP) and cardiovascular disease differs between men and women. We performed a systematic review with meta-analysis to compare reliably sex-specific associations between SBP and cardiovascular risk. Methods-PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and March 31, 2012. Studies were selected if they presented sex-specific estimates, with associated variability, of the relative risk for either ischemic heart disease or stroke according to SBP. The data were pooled using random effects models with inverse variance weighting, and estimates of the ratio of the relative risks per 10 mm Hg increment in SBP, comparing women with men, were derived. Results-Data from 124 prospective cohort studies, including information on 1197 472 individuals (44% women) and 26 176 stroke and 24 434 ischemic heart disease events, were included. Overall, there was no evidence to suggest a sex ...