Impact of preventable risk factors on stroke in the EPICOR study: does gender matter?
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The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort.
43,976 participants, age 34–75, and free of cardiovascular disease at baseline (1993–1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models.
We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4–28%) for smoking and 14% (95% CI 5–22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9–26%) followed by smoking 15% (95% CI 7–22%). Their combination was 46% (95% CI 32–58%) in males and 48% (95% CI 35–59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15–27%) females 9% (95% CI 1–17%)].
Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.
KeywordsStroke Gender medicine Risk factors Cohort study Population-attributable fraction Preventive fraction
EPICOR is supported by Compagnia di San Paolo. The Italian EPIC collaboration is supported by the Italian Association for Cancer Research (AIRC). The founders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
Authors have no conflicts of interest in connection with the paper.
All participants gave written informed consent, and the study was approved by the local ethics committees in the participating countries and the ethical review board of the International Agency for Research on Cancer (IARC).
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