This Article Full Text Full Text (PDF) All Versions of this Article: 37/7/1663    most recent 01.STR.0000226604.10877.fcv1 Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Harmsen, P. Articles by Wilhelmsen, L. Search for Related Content PubMed PubMed Citation Articles by Harmsen, P. Articles by Wilhelmsen, L. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Epidemiology Risk Factors

(Stroke. 2006;37:1663.)
© 2006 American Heart Association, Inc.

Original Contributions

Long-Term Risk Factors for Stroke

Twenty-Eight Years of Follow-Up of 7457 Middle-Aged Men in Göteborg, Sweden

Per Harmsen, MD; Georg Lappas, BSc; Annika Rosengren, MD, PhD Lars Wilhelmsen, MD, PhD

From the Institute of Clinical Neuroscience (P.H.), Sahlgrenska University Hospital; the Cardiovascular Institute (G.L., L.W.), Section of Preventive Cardiology, Sahlgrenska University Hospital; and the Department of Medicine (A.R.), Sahlgrenska University Hospital/Östra, Göteborg, Sweden.

Correspondence to Professor Lars Wilhelmsen, the Cardiovascular Institute Haraldsgatan 5, SE-41314 Göteborg, Sweden. E-mail lars.wilhelmsen{at}a-plusscience.com

Background and Purpose— To estimate the predictive value of risk factors for stroke measured in midlife over follow-up extending through 28 years.

Methods— A cohort of 7457 men 47 to 55 years of age and free of stroke at baseline year 1970 were examined. Risk of stroke was analyzed for the entire period and for 0 to 15, 16 to 21, and 22 to 28 years of follow-up using age-adjusted and multiple Cox regression analyses.

Results— Age, diabetes, and high blood pressure were independently associated with increased risk of stroke for the entire 28 years and for each of the periods. Previous transient ischemic attacks, atrial fibrillation, history of chest pain, smoking, and psychological stress were independently related to stroke for the entire follow-up period and also during the first 1 or 2 successive periods. Family history of stroke or of coronary disease carried no independent prognostic information, nor did serum cholesterol. Elevated body mass index predicted stroke during the later part of the follow-up and so did (almost) low physical activity during leisure time, together with antihypertensive medication at baseline.

Conclusions— High blood pressure and diabetes retain their importance as stroke risk factors also over an extended follow-up into old age. A family history of cardiovascular disease was not significantly related to outcome. Transient ischemic attacks, atrial fibrillation, stress, smoking, and a history of chest pain were associated with outcome only for the first or the first 2 periods. High body mass index and antihypertensive medication at baseline emerged as risk factors in the second and third decades.

Key Words: risk factors • stroke

This article has been cited by other articles:

				D. J. Betteridge, R. A. DeFronzo, and R. J. Chilton PROactive: time for a critical appraisal Eur. Heart J., April 2, 2008; 29(8): 969 - 983. [Abstract] [Full Text] [PDF]

				S. Rastas, A. Verkkoniemi, T. Polvikoski, K. Juva, L. Niinisto, K. Mattila, E. Lansimies, T. Pirttila, and R. Sulkava Atrial Fibrillation, Stroke, and Cognition: A Longitudinal Population-Based Study of People Aged 85 and Older Stroke, May 1, 2007; 38(5): 1454 - 1460. [Abstract] [Full Text] [PDF]