Modifiable Etiological Factors and the Burden of Stroke from the Rotterdam Study: A Population-Based Cohort Study

English version České info

Background:
Stroke prevention requires effective treatment of its causes. Many etiological factors for stroke have been identified, but the potential gain of effective intervention on these factors in terms of numbers of actually prevented strokes remains unclear because of the lack of data from cohort studies. We assessed the impact of currently known potentially modifiable etiological factors on the occurrence of stroke.

Methods and Findings:
This population-based cohort study was based on 6,844 participants of the Rotterdam Study who were aged ≥55 y and free from stroke at baseline (1990–1993). We computed population attributable risks (PARs) for individual risk factors and for risk factors in combination to estimate the proportion of strokes that could theoretically be prevented by the elimination of etiological factors from the population.

The mean age at baseline was 69.4 y (standard deviation 6.3 y). During follow-up (mean follow-up 12.9 y, standard deviation 6.3 y), 1,020 strokes occurred. The age -⁠ and sex-adjusted combined PAR of prehypertension/hypertension, smoking, diabetes mellitus, atrial fibrillation, coronary disease, and overweight/obesity was 0.51 (95% CI 0.41–0.62) for any stroke; hypertension and smoking were the most important etiological factors. C-reactive protein, fruit and vegetable consumption, and carotid intima-media thickness in combination raised the total PAR by 0.06. The PAR was 0.55 (95% CI 0.41–0.68) for ischemic stroke and 0.70 (95% CI 0.45–0.87) for hemorrhagic stroke.

The main limitations of our study are that our study population comprises almost exclusively Caucasians who live in a middle and high income area, and that risk factor awareness is higher in a study cohort than in the general population.

Conclusions:
About half of all strokes are attributable to established causal and modifiable factors. This finding encourages not only intervention on established etiological factors, but also further study of less well established factors.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Modifiable Etiological Factors and the Burden of Stroke from the Rotterdam Study: A Population-Based Cohort Study. PLoS Med 11(4): e32767. doi:10.1371/journal.pmed.1001634
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001634

Souhrn

Zdroje

1. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 202 : 1028–1034.

2. HankeyGJ (2006) Potential new risk factors for ischemic stroke: what is their potential? Stroke 37 : 2181–2188.

3. GoldsteinLB, BushnellCD, AdamsRJ, AppelLJ, BraunLT, et al. (2011) Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42 : 517–584.

4. Rothman KJ, Greenland S, editors (1998) Modern epidemiology, 2nd edition. Philadelphia: Lippincott Williams & Wilkins.

5. Rothman KJ GS (1998) Causation and causal inference. In: Rothman KJ, Greenland S, editors. Modern epidemiology, 2nd edition. Philadelphia: Lipincott Williams & Wilkins. pp. 7–28.

6. MallmannAB, FuchsSC, GusM, FuchsFD, MoreiraLB (2012) Population-attributable risks for ischemic stroke in a community in South Brazil: a case-control study. PLoS ONE 7: e35680.

7. O'DonnellMJ, XavierD, LiuL, ZhangH, ChinSL, et al. (2010) Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 376 : 112–123.

8. HofmanA, Darwish MuradS, van DuijnCM, FrancoOH, GoedegebureA, et al. (2013) The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 28 : 889–926.

9. HatanoS (1976) Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 54 : 541–553.

10. BosMJ, van RijnMJ, WittemanJC, HofmanA, KoudstaalPJ, et al. (2007) Incidence and prognosis of transient neurological attacks. JAMA 298 : 2877–2885.

11. ClarkTG, AltmanDG, De StavolaBL (2002) Quantification of the completeness of follow-up. Lancet 359 : 1309–1310.

12. RoseGA (1962) The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ 27 : 645–658.

13. BosMJ, SchipperCM, KoudstaalPJ, WittemanJC, HofmanA, et al. (2006) High serum C-reactive protein level is not an independent predictor for stroke: the Rotterdam Study. Circulation 114 : 1591–1598.

14. BotsML, HoesAW, KoudstaalPJ, HofmanA, GrobbeeDE (1997) Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 96 : 1432–1437.

15. van den BrandtPA, GoldbohmRA, van 't VeerP, VolovicsA, HermusRJ, et al. (1990) A large-scale prospective cohort study on diet and cancer in The Netherlands. J Clin Epidemiol 43 : 285–295.

16. BosMJ, KoudstaalPJ, HofmanA, WittemanJC, BretelerMM (2006) Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study. Stroke 37 : 1503–1507.

17. EngelhartMJ, GeerlingsMI, RuitenbergA, van SwietenJC, HofmanA, et al. (2002) Dietary intake of antioxidants and risk of Alzheimer disease. JAMA 287 : 3223–3229.

18. Gail D (2002) Interactive Risk Attributable Program, version 2.2 [computer program]. Available: http://dceg.cancer.gov/tools/risk-assessment/irap. Accessed 28 March 2014.

19. DehghanA, van HoekM, SijbrandsEJ, StijnenT, HofmanA, et al. (2007) Risk of type 2 diabetes attributable to C-reactive protein and other risk factors. Diabetes Care 30 : 2695–2699.

20. EngelLS, ChowWH, VaughanTL, GammonMD, RischHA, et al. (2003) Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst 95 : 1404–1413.

21. WalterSD (1998) Attributable risk in practice. Am J Epidemiol 148 : 411–413.

22. GreenlandS (2001) Attributable fractions: bias from broad definition of exposure. Epidemiology 12 : 518–520.

23. BushnellCD (2008) Stroke and the female brain. Nat Clin Pract Neurol 4 : 22–33.

24. WangX, DongY, QiX, HuangC, HouL (2013) Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis. Stroke 44 : 1833–1839.

25. WhisnantJP (1997) Modeling of risk factors for ischemic stroke. The Willis Lecture. Stroke 28 : 1840–1844.

26. EzzatiM, HoornSV, RodgersA, LopezAD, MathersCD, et al. (2003) Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 362 : 271–280.

27. C Reactive Protein Coronary Heart Disease Genetics Collaboration (2011) WensleyF, GaoP, BurgessS, KaptogeS, et al. (2011) Association between C reactive protein and coronary heart disease: Mendelian randomisation analysis based on individual participant data. BMJ 342: d548.

28. Castilla GuerraL, del Carmen Fernandez MorenoM, Lopez ChozasJM, Jimenez HernandezMD (2008) Statins in stroke prevention: what an internist should know. Eur J Intern Med 19 : 8–14.

29. BosD, PortegiesML, van der LugtA, BosMJ, KoudstaalPJ, et al. (2014) Intracranial carotid artery atherosclerosis and the risk of stroke in whites: the Rotterdam study. JAMA Neurol E-pub ahead of print. doi:10.1001/jamaneurol.2013.6223