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(Stroke. 1995;26:2004-2010.)
© 1995 American Heart Association, Inc.

Articles

Respiratory Function and Risk of Stroke

S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP Shah Ebrahim, FRCP

From the Department of Public Health, Royal Free Hospital School of Medicine, London, UK.

Correspondence to Dr Goya Wannamethee, Department of Public Health, Royal Free Hospital School of Medicine, Rowland Hill St, London NW3 2PF, UK.

Background and Purpose This report examines the relationship between lung function and risk of major stroke events (fatal and nonfatal).

Methods We completed a prospective study of 7735 men aged 40 to 59 years at screening selected at random from one general practice in each of 24 British towns.

Results During the mean follow-up period of 14.8 years, there were 277 major stroke events in the 7650 men with data on forced expiratory volume in 1 second (FEV₁). After exclusion of 499 men with definite myocardial infarction, stroke, or atrial fibrillation at screening, 7151 men experienced 239 major stroke events. Lower levels of FEV₁ were associated with a significant increase in risk of stroke even after adjustment for age, smoking, social class, physical activity, alcohol intake, systolic blood pressure, antihypertensive treatment, diabetes, and preexisting ischemic heart disease. Relative risk in the low third (<3.10 L) versus high third (>3.65 L) was 1.4 (95% confidence interval, 1.0 to 2.0). The inverse association between FEV₁ and stroke was only apparent in older men, current nonsmokers, hypertensive men, and men with preexisting ischemic heart disease. Lower FEV₁ was associated with higher rates of stroke in hypertensive men irrespective of smoking status. Inclusion of FEV₁ in a risk score for stroke provided only a small increase in the absolute risk or the yield of cases in the top fifth of the score distribution during the follow-up period.

Conclusions Lower levels of FEV₁ are associated with an increased risk of stroke in those already at high risk, eg, those with ischemic heart disease or hypertension. However, the association is not strong enough to warrant the use of FEV₁ in making clinical decisions regarding the treatment of hypertension as it relates to the prevention of stroke.

Key Words: England • lung • respiratory function tests • risk factors • stroke

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