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Different risk factor profiles between subtypes of ischemic stroke. A case-control study in Korean men

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Abstract

Ischemic stroke is composed of subtypes with variable underlying pathogenesis and studies on ischemic stroke as a whole may inadequately evaluate risk factors, being influenced by subtype distribution among studied population. This study aimed to evaluate risk factors associated with individual ischemic stroke subtypes defined by the Trial of ORG10172 in Acute Stroke Treatment. In a case-control study (290 first-ever ischemic stroke cases and 1160 individually matched controls without stroke) nested within Korean male public servants cohort, a range of potential risk factors measured at periodic health surveys prior to the onset of stroke event were examined using conditional logistic regression analysis. Increased risk for large-artery atherosclerosis was associated with hypercholesterolemia (≥ 6.2 mmol/L), hypertension, and smoking. Increased risk for small-artery occlusion was associated with hypertension, hyperglycemia (≥ 7.0 mmol/L), and frequent alcohol intake. No specific risk factor was identified for cardioembolism. For combined ischemic stroke, hypercholesterolemia, hyperglycemia, hypertension, and smoking were associated with the increased risk, but the relative odds were much smaller than those estimated from subtype analysis. Significance of risk factors evaluated for subtypes, rather than ischemic stroke as a whole, should be reflected in preventive efforts against the burden of ischemic stroke.

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Abbreviations

LAA:

large artery atherosclerosis

SAO:

small artery occlusion

CE:

cardiac embolism

UE:

undetermined etiology

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

References

  1. LB Goldstein R Adams K Becker et al. (2001) ArticleTitlePrimary prevention of ischemic stroke. A statement for healthcare professionals from the stroke council of the American Heart Association Stroke 32 280–299 Occurrence Handle11136952

    PubMed  Google Scholar 

  2. S Ebrahim RH Harwood (1999) Stroke: Epidemiology, Evidence and Clinical Practice 2nd eds Oxford university press Oxford

    Google Scholar 

  3. GW Petty RD Brown JP Whisnant JD Sicks WM O’Fallon DO Wiebers (1999) ArticleTitleIschemic stroke subtypes. A population-based study of incidence and risk factors Stroke 30 2513–2516 Occurrence Handle10582970

    PubMed  Google Scholar 

  4. A Arboix C Morcillo L Garcīa-eroles M Oliveres J Massons C Targa (2000) ArticleTitleDifferent vascular risk factor profiles in ischemic stroke subtypes: a study from the “Sagrat Cor Hospital of Barcelona Stroke Registry” Acta Neurol Scand 102 264–270 Occurrence Handle10.1034/j.1600-0404.2000.102004264.x Occurrence Handle11071113

    Article  PubMed  Google Scholar 

  5. AJ Grau C Weimer F Buggle et al. (2001) ArticleTitleRisk factors, outcome, and treatment in subtypes of ischemic stroke. The German stroke data bank Stroke 32 2559–2566 Occurrence Handle11692017

    PubMed  Google Scholar 

  6. UGR Schulz PM Rothwell (2003) ArticleTitleDifferences in vascular risk factors between etiological subtypes of ischemic stroke. Importance of population-based studies Stroke 34 2050–2059 Occurrence Handle10.1161/01.STR.0000079818.08343.8C Occurrence Handle12829866

    Article  PubMed  Google Scholar 

  7. MA Albanese WR Clarke HP Adams RF Woolson (1994) ArticleTitleTOAST investigators. Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke. The program developed for the trial of Org 10172 in acute stroke treatment (TOAST) Stroke 25 1746–1751 Occurrence Handle8073453

    PubMed  Google Scholar 

  8. GC Hawkins R Bonita JB Broad NE Anderson (1995) ArticleTitleInadequacy of clinical scoring systems to differentiate stroke subtypes in population-based studies Stroke 26 1338–1342 Occurrence Handle7631333

    PubMed  Google Scholar 

  9. J Bamford (1992) ArticleTitleClinical examination in diagnosis and subclassification of stroke Lancet 339 400–402 Occurrence Handle10.1016/0140-6736(92)90085-H Occurrence Handle1346666

    Article  PubMed  Google Scholar 

  10. J Woo CW Lam R Kay HY Wong R Teoh MG Nicholls (1990) ArticleTitleAcute and long-term changes in serum lipids after acute stroke Stroke 21 1407–1411 Occurrence Handle2219204

    PubMed  Google Scholar 

  11. RJ Butterworth WJ Marshall PMW Bath (1997) ArticleTitleChanges in serum lipid measurements following acute ischaemic stroke Cerebrovasc Dis 7 10–13

    Google Scholar 

  12. HP Adams SuffixJr. BH Bendixen LJ Kappelle J Biller BB Love DL Gordon et al. (1993) ArticleTitleClassification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial Stroke 24 35–41 Occurrence Handle7678184

    PubMed  Google Scholar 

  13. AV Chobanian GL Bakris HR Black et al. (2003) ArticleTitleThe seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure The JNC 7 Report. JAMA 289 2560–2571 Occurrence Handle10.1001/jama.289.19.2560

    Article  Google Scholar 

  14. InstitutionalAuthorNameWorld Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. Part I: Diagnosis and classification of diabetes mellitus WHO Geneva

    Google Scholar 

  15. JK Park KS Kim CB Kim et al. (2000) ArticleTitleThe accuracy of ICD codes for cerebrovascular diseases in medical insurance claims Korean J Prev Med. 33 IssueID1 76–82

    Google Scholar 

  16. JD Neaton H Blackburn D Jacobs et al. (1992) ArticleTitleSerum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial Arch Intern Med 152 1490–1500 Occurrence Handle10.1001/archinte.152.7.1490 Occurrence Handle1627030

    Article  PubMed  Google Scholar 

  17. H Tanaka Y Ueda M Hayashi C Date T Baba H Yamashita et al. (1982) ArticleTitleRisk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community Stroke. 13 62–73 Occurrence Handle7064181

    PubMed  Google Scholar 

  18. InstitutionalAuthorNameProspective studies collaboration (1995) ArticleTitleCholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts Lancet. 346 1647–1653

    Google Scholar 

  19. CD Furberg Hp Adams SuffixJr WB Applegate et al. (1994) ArticleTitleEffects of lovastatin on early carotid atherosclerosis and cardiovascular events: Asymptomatic carotid Artery Progression Study (ACAPS) research group Circulation. 90 1679–1687 Occurrence Handle7734010

    PubMed  Google Scholar 

  20. J Biller BB Love (1993) ArticleTitleDiabetes and stroke Med Clin North Am 77 95–110 Occurrence Handle8419726

    PubMed  Google Scholar 

  21. LR Caplan (1996) ArticleTitleDiabetes and brain ischemia Diabetes 45 S95–S97 Occurrence Handle8674904

    PubMed  Google Scholar 

  22. PA Wolf RB D’Agostino WB Kannel R Bonita AJ Belanger (1988) ArticleTitleCigarette smoking as a risk factor for stroke. The Framingham study JAMA 259 1025–1029 Occurrence Handle3339799

    PubMed  Google Scholar 

  23. GA Donnan JJ McNeil MA Adena AE Doyle HM O’Malley GC Neill (1989) ArticleTitleSmoking as a risk factor for cerebral ischaemia Lancet. 16 643–647

    Google Scholar 

  24. DL Gordon BH Bendixen HP Adams SuffixJr. W Clarke LJ Kappelle RF Woolson (1993) ArticleTitleInterphysician agreement in the diagnosis of subtypes of acute ischemic stroke: implications for clinical trials. The TOAST Investigators Neurology 43 1021–1027 Occurrence Handle8492920

    PubMed  Google Scholar 

  25. PL Kolominsky-Rabas M Weber O Gefeller B Neundoerfer PU Heuschmann (2001) ArticleTitleEpidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study Stroke 32 2735–2740 Occurrence Handle11739965

    PubMed  Google Scholar 

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Song, YM., Kwon, S.U., Sung, J. et al. Different risk factor profiles between subtypes of ischemic stroke. A case-control study in Korean men. Eur J Epidemiol 20, 605–612 (2005). https://doi.org/10.1007/s10654-005-6831-5

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  • DOI: https://doi.org/10.1007/s10654-005-6831-5

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