Published Online
on April 8, 2004

A more recent version of this article appeared on May 1, 2004

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Submitted on January 8, 2004
Accepted on January 23, 2004

Prevalence and Magnitude of Classical Risk Factors for Stroke in a Cohort of 5092 Chinese Steelworkers Over 13.5 Years of Follow-up

Xiao-Fei Zhang MD, MS^*; John Attia MD, PhD; Catherine D’Este PhD; and Xue-Hai Yu MD

From the Centre for Clinical Epidemiology and Biostatistics (X.-F.Z, J.A., C.D.), School of Medical Practice and Population Health, The University of Newcastle, Australia; Department of Epidemiology (X.-F.Z.), Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College, China; Hospital of the Capital Iron and Steel Complex (X.-H.Y.), Beijing, China.

^* To whom correspondence should be addressed. E-mail: xiaofei.zhang{at}studentmail.newcastle.edu.au.

Background and Purpose--Stroke is the most common manifestation of cardiovascular disease (CVD) among Chinese men. This study addresses the prevalence and magnitude of classic CVD risk factors associated with total, ischemic, and hemorrhagic stroke in a Chinese cohort of at-risk men, compared with white populations. We also address which blood pressure index: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) is the best predictor of stroke.

Methods--A cohort of 5092 male steelworkers (aged 18 to 74 years) recruited between 1974 to 1980 was followed up for an average of 13.5 years. The results showed that the risk ratios (RRs) of stroke associated with classic risk factors in this Asian population were not different than in whites, except for blood pressure. The RRs of total stroke for each 10mm Hg rise in SBP and DBP in this Asian group (1.4 and 1.8, respectively) were higher than in whites (1.2 to 1.3 and 1.2 to 1.5, respectively). The population attributable risk (PAR) for hypertension (160/95 mm Hg cutoff) to stroke was higher in Asians (ie, 31% for ischemic and 42% for hemorrhagic stroke) than in whites (25% and 34%, respectively).

Conclusion--Our results indicate that hypertension is a greater risk factor for stroke in Asians than whites, especial for hemorrhagic stroke. The most predictive blood pressure (BP) index for stroke is MAP. However, the prevalence or magnitude of these traditional risk factors appears unlikely to explain the differing spectrum of CVD among Asians.

Key words: blood pressure • body mass index • cardiovascular diseases • cholesterol • cigarette smoking • cohort studies • race, Asiatic • stroke

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