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From the University of New South Wales Lipid Research Department, St
Vincent's Hospital, Sydney, Australia (L.A.S., J.S.); Faculty of Health,
University of Western Sydney, Sydney, Australia (J.M.); and Department of
Social Medicine, Hebrew University, Hadassah Hospital, Jerusalem, Israel
(Y.F.).
Correspondence to Prof Leon Simons, Lipid Research Department, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia. E-mail exb0072{at}vmsuser.acsu.unsw.edu.au
Background and Purpose—One in 10
deaths in Australia is due to stroke. The predictors of
ischemic stroke have not been well defined, although
hypertension, atrial fibrillation, and previous stroke have been
consistently reported. We report on 98 months' follow-up in a
prospective study of cardiovascular disease in the
Australian elderly, the Dubbo Study.
Methods—The cohort, first examined in 1988, was composed of 2805
men and women 60 years and older. The prediction of ischemic
stroke by potential risk factors was examined in a Cox proportional
hazards model, after linkage to hospital and death records.
Results—Three hundred six men and women manifested an
ischemic stroke event (ICD-9-CM 433 to 437), and 95 subjects
suffered a fatal stroke event. In the multivariate
model, the significant independent predictors of stroke were advancing
age, female sex (48% lower risk), being married (30% lower risk),
prior history of stroke (227% higher risk), use of antihypertensive
drugs (37% higher risk), belonging to the highest category of blood
pressure reading (67% higher risk), presence of atrial fibrillation
(58% higher risk), HDL cholesterol (36% lower risk for
each 1-mmol/L increment), impaired peak expiratory flow (77% higher
risk for tertile I than for tertile III), physical disability (59%
higher risk), and depression score (41% higher risk for tertile III
than for tertile I).
Conclusions—These findings suggest that morbidity and mortality
associated with ischemic stroke can be predicted by various
clinical indicators, some of which may be amenable to intervention. The
matters of impaired peak expiratory flow, depression score, and
ischemic stroke require further study.
© 1998 American Heart Association, Inc.
Original Contributions
Risk Factors for Ischemic Stroke
Dubbo Study of the Elderly
Key Words: elderly • prospective studies • risk factors • stroke, ischemic
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