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Joint effects of risk factors for stroke and transient ischemic attack in a German population

The EPIC Potsdam Study

Journal of Neurology volume 254, pages 315–321 (2007)Cite this article

Abstract

Background

Single, modifiable risk factors for stroke have extensively been studied. In contrast, differences of their combined effects among stroke and transitoy ischemic attack (TIA) have been rarely investigated. The aim of the present study was to assess single and joint effects of risk factors on the incidence of stroke and TIA and to compare their magnitudes in a large population-based German cohort.

Methods

Incident cases of stroke and TIA were identified among 25538 participants (aged 35–65 at baseline) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Relative risks for stroke and TIA related to modifiable risk factors were estimated using Cox proportional hazard models.

Results

During 4.3 years of follow-up 100 stroke cases and 112 TIA cases occurred. Incidences of stroke and TIA were 91.7 and 102.7 per 100 000 person-years, respectively. Relative risks for ischemic stroke (RR 5.12, 95% CI 1.49–17.6, p for trend <0.0001) and for TIA (RR 3.08, 95% CI 1.00–9.44, p for trend <0.024) were highest among participants having 4 or 5 modifiable risk factors. 58.5% of ischemic strokes and 26.2% of TIA cases were attributable to the 5 risk factors hypertension, diabetes mellitus, high alcohol consumption, hyperlipidemia, and smoking.

Conclusion

Our data indicate that classical risk factors may explain almost 60% of ischemic stroke but only one in four TIA cases. Analysing potential differences of known risk factors between ischemic stroke and TIAs and the identification of other determinants of ischemic attacks are important steps to better explain the burden of stroke.

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Acknowledgments

The authors thank all study participants for their cooperation. We especially thank our study physician Wolfgang Fleischhauer and our data manager Kay Behling and Ellen Kohlsdorf.

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Affiliations

  1. Dept. of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany

    Cornelia Weikert MD, MPH

  2. Dept. of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany

    Cornelia Weikert MD, MPH, Christin Heidemann MSc, Manuela M. Bergmann PhD, Kurt Hoffmann PhD, Kerstin Klipstein-Grobusch MSc, PhD & Heiner Boeing MSPH, PhD

  3. Institute of Epidemiology and Social Medicine, University of Muenster, Germany

    Klaus Berger MD, MPH

  4. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Kerstin Klipstein-Grobusch MSc, PhD

Authors
  1. Cornelia Weikert MD, MPH
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  2. Klaus Berger MD, MPH
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  3. Christin Heidemann MSc
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  4. Manuela M. Bergmann PhD
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  5. Kurt Hoffmann PhD
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  6. Kerstin Klipstein-Grobusch MSc, PhD
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  7. Heiner Boeing MSPH, PhD
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Corresponding author

Correspondence to Cornelia Weikert MD, MPH.

Additional information

Received in revised form: 7 July 2006

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Weikert, C., Berger, K., Heidemann, C. et al. Joint effects of risk factors for stroke and transient ischemic attack in a German population. J Neurol 254, 315–321 (2007). https://doi.org/10.1007/s00415-006-0358-x

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  • DOI: https://doi.org/10.1007/s00415-006-0358-x

Keywords

  • stroke
  • TIA
  • incidence
  • relative risk
  • epidemiology