Manifestations of Coronary Disease Predisposing to Stroke: The Framingham Study

Abstract

The relation of coronary heart disease to development of strokes in general and brain infarction in particular has been examined prospectively over 24 years of follow-up in the Framingham Study cohort. In the course of 24 years of biennial surveillance, there were 169 strokes in men and 175 in women aged 45–84; brain infarctions occurred in 100 men and 107 women, comprising 60% of strokes. Routine ECG’s chest X-rays coronary heart disease and cardiac failure status were ascertained biennially on regular examinations and risk of strokes determined in relation to these. Age and other stroke risk factors (including blood pressure, diabetes cigarettes and lipids were also routinely measured and were taken into account in multivariate analysis of the net and joint effects of CHD manifestations as precursors of strokes. The incidence of stroke was lower and stroke occurred later in life than coronary heart disease. Stroke incidence in men lagged that of myocardial infarction by more than 10 years. In women, the incidence of brain and myocardial infarction was similar. In men the average annual incidence of myocardial infarction (8.5/1000) was three times that for brain infarction (2.7/1000).¹