Published online before print August 24, 2006, doi: 10.1161/01.STR.0000239694.19359.88
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2006;37:2493.)
© 2006 American Heart Association, Inc.
Original Contributions |
Risk Factors for Ischemic Stroke Subtypes
The Atherosclerosis Risk in Communities Study
From the Division of Epidemiology and Community Health (T.O., E.S., A.R.F.), University of Minnesota, Minneapolis; Osaka Medical Center for Health Science and Promotion (T.O.), Osaka, Japan; the Departments of Biostatistics (L.E.C.) and Epidemiology (W.D.R.), University of North Carolina, Chapel Hill; and the Department of Medicine (T.H.M.), University of Mississippi Medical Center, Jackson.
Correspondence to Aaron R. Folsom, MD, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN 55454-1015. E-mail folsom{at}epi.umn.edu
Background and Purpose— To evaluate risk factors for ischemic stroke by its subtypes may contribute to more effective prevention of ischemic stroke, but few prospective studies have characterized risk factors for specific subtypes of ischemic stroke.
Methods— Between 1987 and 1989, 14 448 men and women aged 45 to 64 years and free of clinical stroke took part in the first examination of the Atherosclerosis Risk in Communities study. The incidence of stroke was ascertained from hospital surveillance records.
Results— During an average follow-up of 13.4-years, 531 incident ischemic strokes occurred (105 lacunar, 326 nonlacunar, and 100 cardioembolic). Blacks had a 3-fold higher multivariate-adjusted risk ratio of lacunar stroke compared with whites. No racial difference in nonlacunar or cardioembolic strokes was found after adjusting for prevalent risk factors. In addition to traditional risk factors, nontraditional risk factors, such as waist-to-hip ratio, history of coronary heart disease, left ventricular hypertrophy, lipoprotein(a), and von Willebrand factor, were associated with increased risk for nonlacunar stroke, whereas lacunar stroke was related to only 1 nontraditional risk factor, white blood cell count. The population-attributable fraction (PAF) for hypertension was 
35% for all ischemic stroke subtypes. The respective PAFs for diabetes and current smoking were 26.3% and 22.0% for lacunar versus 11.3% and 11.4% for nonlacunar stroke. The PAF for elevated von Willebrand factor was greater than that for current smoking for cardioembolic stroke.
Conclusions— The impact of traditional and nontraditional risk factors other than hypertension on the incidence of ischemic stroke varied according to its subtype.
Key Words: brain infarction • embolic stroke • epidemiology • lacunar infarction • risk factors
This article has been cited by other articles:
 |
|
 |
|
  T. Ohira, J. M. Peacock, H. Iso, L. E. Chambless, W. D. Rosamond, and A. R. Folsom Serum and Dietary Magnesium and Risk of Ischemic Stroke: The Atherosclerosis Risk in Communities Study Am. J. Epidemiol., June 15, 2009; 169(12): 1437 - 1444. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-Y. Chuang, C.-H. Bai, W.-H. Chen, L.-M. Lien, and W.-H. Pan Fibrinogen Independently Predicts the Development of Ischemic Stroke in a Taiwanese Population: CVDFACTS Study Stroke, May 1, 2009; 40(5): 1578 - 1584. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Yahalom, R. Schwartz, Y. Schwammenthal, O. Merzeliak, M. Toashi, D. Orion, B.-A. Sela, and D. Tanne Chronic Kidney Disease and Clinical Outcome in Patients With Acute Stroke Stroke, April 1, 2009; 40(4): 1296 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]
|
|
|
|
|
|
H. Ueshima, A. Sekikawa, K. Miura, T. C. Turin, N. Takashima, Y. Kita, M. Watanabe, A. Kadota, N. Okuda, T. Kadowaki, et al. Cardiovascular Disease and Risk Factors in Asia: A Selected Review Circulation, December 16, 2008; 118(25): 2702 - 2709. [Full Text] [PDF]
|
|
|
|
|
|
Y. Winter, S. Rohrmann, J. Linseisen, O. Lanczik, P. A. Ringleb, J. Hebebrand, and T. Back Contribution of Obesity and Abdominal Fat Mass to Risk of Stroke and Transient Ischemic Attacks Stroke, December 1, 2008; 39(12): 3145 - 3151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Y. Chan, F. Andreotti, and R. C. Becker Hypercoagulable States in Cardiovascular Disease Circulation, November 25, 2008; 118(22): 2286 - 2297. [Full Text] [PDF]
|
|
|
|
 |
|
 F. R Sattler, N. Rajicic, K. Mulligan, K. E Yarasheski, S. L Koletar, A. Zolopa, B. Alston Smith, R. Zackin, B. Bistrian, and for the ACTG 392 Study Team Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial Am. J. Clinical Nutrition, November 1, 2008; 88(5): 1313 - 1321. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W T. Cade Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting Physical Therapy, November 1, 2008; 88(11): 1322 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Pickering, N. H. Miller, G. Ogedegbe, L. R. Krakoff, N. T. Artinian, and D. Goff Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association Hypertension, July 1, 2008; 52(1): 10 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Voeks, L. A. McClure, R. C. Go, R. J. Prineas, M. Cushman, B. M. Kissela, and J. M. Roseman Regional Differences in Diabetes as a Possible Contributor to the Geographic Disparity in Stroke Mortality: The REasons for Geographic And Racial Differences in Stroke Study Stroke, June 1, 2008; 39(6): 1675 - 1680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Matheson, M. S. Player, A. G. Mainous III, D. E. King, and C. J. Everett The Association Between Hay Fever and Stroke in a Cohort of Middle Aged and Elderly Adults J Am Board Fam Med, May 1, 2008; 21(3): 179 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
|
|
L. Castilla-Guerra and M. del Carmen Fernandez-Moreno Stroke in Diabetic Patients: Is It Really a Macrovascular Complication? Stroke, October 1, 2007; 38(10): e106 - e106. [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]
|
|