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Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease

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Abstract

It is uncertain whether the incidence of stroke is increased in patients with chronic obstructive pulmonary disease (COPD), and whether COPD is associated with all subtypes of stroke (i.e. ischemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage). We evaluated the association between COPD and incidence of stroke in a nation-wide cohort study. All individuals between 40 and 84 years of age, hospitalised for COPD between 1987 and 2003 in Sweden were identified in the Swedish hospital discharge register. For each COPD patient (n = 103,419), one reference individual was randomly selected from the general population matched for year of birth, sex and county of residence. After excluding subjects with prior stroke, incidence rates during 10 years follow-up were calculated. Hazard ratios (HR) for stroke comparing COPD patients with reference subjects were estimated using Cox regression adjusting for demographics and comorbidities. Incidence of all-cause stroke (n events = 17,402) was significantly increased in COPD patients compared to reference individuals (HR 1.24, 95 % CI 1.19–1.28), especially during the first 2 years after COPD diagnosis (HR 1.46, 1.37–1.55). Incidences of ischemic stroke (HR 1.20, 1.15–1.25), intracerebral haemorrhage (HR 1.29, 1.16–1.43) and subarachnoid haemorrhage (HR 1.46, 1.16–1.85) were all increased in COPD patients. Incidences of all stroke subtypes are increased in COPD, especially during the first years after COPD diagnosis. The association was independent of several comorbidities, although residual confounding from smoking and hypertension cannot be excluded. A global evaluation of stroke risk factors seems warranted in patients with COPD.

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Acknowledgments

The authors were supported by grants from the Swedish Heart and Lung foundation (Grant Nos. 20100244; 20130249), the Swedish Stroke foundation, the Ernhold Lundström foundation and the Swedish Research council (Grant Nos. 2011-3891; 2014-2265). None of the funders had any role in concept, design, data analysis or interpretation, manuscript preparation or decision to submit, of the present study.

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Authors and Affiliations

  1. Cardiovascular Epidemiology Research Group, Department of Clinical Sciences Malmö, Lund University, CRC Building 60, Floor 13, Jan Waldenströms gata 35, 20502, Malmö, Sweden

    Martin Söderholm, Bo Hedblad & Gunnar Engström

  2. Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden

    Malin Inghammar

  3. Section for Respiratory Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden

    Arne Egesten

  4. Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden

    Martin Söderholm

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  1. Martin Söderholm
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Correspondence to Martin Söderholm.

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Söderholm, M., Inghammar, M., Hedblad, B. et al. Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease. Eur J Epidemiol 31, 159–168 (2016). https://doi.org/10.1007/s10654-015-0113-7

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  • DOI: https://doi.org/10.1007/s10654-015-0113-7

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