on June 11, 2009
Published online before print June 11, 2009, doi: 10.1161/STROKEAHA.109.547869
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Submitted on January 15, 2009
From the Department of Public Health and Clinical Medicine (K.A.), Medical Unit, Umeå University Hospital, Umeå, Sweden; the National Institute for Health and Welfare (J.K., P.J., M.N., K.K.), Helsinki, Finland; the National Centre for Epidemiology, Surveillance and Health Promotion (S.G.), Istituto Superiore di Sanità, Rome, Italy; the Department of Cardiovascular Epidemiology and Prevention (G.B.), National Institute of Cardiology, Warsaw, Poland; Dipartimento de Medicina (G.C.), Prevenzione e Biotecnologie Sanitarie, Università degli Studi Milano-Bicocca, Monza, Italy; the Department of Epidemiology and Public Health (J.D.), Pasteur Institute of Lille, Lille, France; the National Institute of Health and Medical Research (U258; P.D.), Paris, France; the Department of Epidemiology and Public Health (A.E., J.Y.), The Queen's University of Belfast, Belfast, UK; the Department of Epidemiology (J.F.), Faculty of Medicine, Toulouse–Purpan, Toulouse, France; the Department of Epidemiology and Public Health (B.H.), Louis Pasteur University, Faculty of Medicine, Strasbourg, France; the Research Centre for Prevention and Health (T.J.), Capital Region, Denmark; Kaunas University of Medicine (A.T.), Institute of Cardiology, Kaunas, Lithuania; Centro di Prevenzione Cardiovasculare (D.V.), Agenmzia Regionale della Sanità Friuli Venezia Giulia, Udine, Italy; the Department of Medicine (P.-G.W.), Umeå University Hospital, Umeå, Sweden; and the Indic Society for Education and Development (INSEED; S.K.), Nashik, India. * To whom correspondence should be addressed. E-mail: Kjell.Asplund{at}branneriet.se.
Background and Purpose—Within the framework of the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project, the variations in impact of classical risk factors of stroke by population, sex, and age were analyzed. Methods—Follow-up data were collected in 43 cohorts in 18 populations in 8 European countries surveyed for cardiovascular risk factors. In 93 695 persons aged 19 to 77 years and free of major cardiovascular disease at baseline, total observation years were 1 234 252 and the number of stroke events analyzed was 3142. Hazard ratios were calculated by Cox regression analyses. Results—Each year of age increased the risk of stroke (fatal and nonfatal together) by 9% (95% CI, 9% to 10%) in men and by 10% (9% to 10%) in women. A 10-mm Hg increase in systolic blood pressure involved a similar increase in risk in men (28%; 24% to 32%) and women (25%; 20% to 29%). Smoking conferred a similar excess risk in women (104%; 78% to 133%) and in men (82%; 66% to 100%). The effect of increasing body mass index was very modest. Higher high-density lipoprotein cholesterol levels decreased the risk of stroke more in women (hazard ratio per mmol/L 0.58; 0.49 to 0.68) than in men (0.80; 0.69 to 0.92). The impact of the individual risk factors differed somewhat between countries/regions with high blood pressure being particularly important in central Europe (Poland and Lithuania). Conclusions—Age, sex, and region-specific estimates of relative risks for stroke conferred by classical risk factors in various regions of Europe are provided. From a public health perspective, an important lesson is that smoking confers a high risk for stroke across Europe.
Revised on February 23, 2009
Accepted on March 12, 2009
Relative Risks for Stroke by Age, Sex, and Population Based on Follow-Up of 18 European Populations in the MORGAM Project
Kjell Asplund MD, PhD*;
Key words: blood pressure • cholesterol • cohort studies • smoking • stroke risk factors