Published Online
on August 24, 2006

A more recent version of this article appeared on October 1, 2006

This Article Full Text (PDF) All Versions of this Article: 37/10/2493    most recent 01.STR.0000239694.19359.88v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ohira, T. Articles by Folsom, A. R. Search for Related Content PubMed PubMed Citation Articles by Ohira, T. Articles by Folsom, A. R. Pubmed/NCBI databases Substance via MeSH Related Collections Epidemiology Risk Factors Acute Cerebral Infarction Cerebral Lacunes Embolic stroke

Submitted on April 4, 2006
Revised on June 27, 2006
Accepted on July 11, 2006

Risk Factors for Ischemic Stroke Subtypes. The Atherosclerosis Risk in Communities Study

Tetsuya Ohira MD; Eyal Shahar MD; Lloyd E. Chambless PhD; Wayne D. Rosamond PhD; Thomas H. Mosley Jr PhD; and Aaron R. Folsom MD^*

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.

^* To whom correspondence should be addressed. 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. 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]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, 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]