Identifying Target Risk Factors Using Population Attributable Risks of Ischemic Stroke by Age and Sex
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Background and Purpose Estimating age- and sex-specific population attributable risks (PARs) of major risk factors for stroke may be a useful strategy to identify risk factors for targeting preventive strategies. Methods For this case-control matched study, consecutive patients aged 18-90 years and admitted to nine nationwide hospitals with acute ischemic stroke between December 2008 and June 2010, were enrolled as cases. Controls, individually matched by age and sex, were chosen from the 4th Korean National Health & Nutrition Examination Survey (2008-2010). Based on odds ratios and prevalence, standardized according to the age and sex structure of the Korean population, PARs of major risk factors were estimated according to age (young, ≤45; middle-aged, 46-65; and elderly, ≥66 years) and sex subgroups. Results In 4,743 matched case-control sets, smoking (PAR, 45.1%) was the greatest contributing risk factor in young men, followed by hypertension (28.5%). In middle-aged men, the greatest contributing factors were smoking (37.4%), hypertension (22.7%), and diabetes (14.6%), whereas in women the greatest factors were hypertension (22.7%) and stroke history (10.6%). In the elderly, hypertension was the leading factor in men (23.7%) and women (23.4%). Other noticeable factors were stroke history (men, 19.7%; women, 17.3%) and diabetes (men, 12.5%; women, 15.1%). In young women, risk factors with a PAR greater than 10% were not found. Conclusions Smoking cessation in young people and hypertension and diabetes control in older people may be effective in reducing the burden of stroke on the population. In the elderly, secondary prevention could also be emphasized.
Abstract
Background and Purpose Estimating age- and sex-specific population attributable risks (PARs) of major risk factors for stroke may be a useful strategy to identify risk factors for targeting preventive strategies. Methods For this case-control matched study, consecutive patients aged 18-90 years and admitted to nine nationwide hospitals with acute ischemic stroke between December 2008 and June 2010, were enrolled as cases. Controls, individually matched by age and sex, were chosen from the 4th Korean National Health & Nutrition Examination Survey (2008-2010). Based on odds ratios and prevalence, standardized according to the age and sex structure of the Korean population, PARs of major risk factors were estimated according to age (young, ≤45; middle-aged, 46-65; and elderly, ≥66 years) and sex subgroups. Results In 4,743 matched case-control sets, smoking (PAR, 45.1%) was the greatest contributing risk factor in young men, followed by hypertension (28.5%). In middle-aged men, the greatest contributing factors were smoking (37.4%), hypertension (22.7%), and diabetes (14.6%), whereas in women the greatest factors were hypertension (22.7%) and stroke history (10.6%). In the elderly, hypertension was the leading factor in men (23.7%) and women (23.4%). Other noticeable factors were stroke history (men, 19.7%; women, 17.3%) and diabetes (men, 12.5%; women, 15.1%). In young women, risk factors with a PAR greater than 10% were not found. Conclusions Smoking cessation in young people and hypertension and diabetes control in older people may be effective in reducing the burden of stroke on the population. In the elderly, secondary prevention could also be emphasized.
참고문헌 (43)
- Feigin VL, "Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010", Lancet, 383, pp.245~254 (2014)
- Rothwell PM, "Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)", Lancet, 363, pp.1925~1933 (2004)
- Gorelick PB, "Stroke prevention", Arch Neurol, 52, pp.347~355 (1995)
- Meschia JF, "Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 3754~3832
- O’Donnell MJ, "Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study", Lancet, 376, pp.112~123 (2010)
- Willey JZ, "Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study", J Am Heart Assoc, 3, pp.e001106~ (2014)
- Bushnell C, "Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 1545~1588
- Khoury JC, "Diabetes mellitus: a risk factor for ischemic stroke in a large biracial population", Stroke, 44, pp.1500~1504 (2013)
- Peters SA, "Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes", Lancet, 383, pp.1973~1980 (2014)
- James PA, "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)", JAMA, 311, pp.507~520 (2014)
- Northridge ME, "Public health methods--attributable risk as a link between causality and public health action", Am J Public Health, 85, pp.1202~1204 (1995)
- Kim AS, "Global variation in the relative burden of stroke and ischemic heart disease", Circulation, 124, pp.314~323 (2011)
- "United Nations DoEaSA. World Population Prospects: The 2012 Revision"[URL]
- Nakayama T, "Population attributable fraction of stroke incidence in middle-aged and elderly people: contributions of hypertension, smoking and atrial fibrillation", Neuroepidemiology, 19, pp.217~226 (2000)
- Martiniuk AL, "Hypertension: its prevalence and population attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region", J Hypertens, 25, pp.73~79 (2007)
- Woodward M, "Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia Pacific region", Int J Epidemiol, 34, pp.1036~1045 (2005)
- Zhang X, "Cholesterol, coronary heart disease, and stroke in the Asia Pacific region", Int J Epidemiol, 32, pp.563~572 (2003)
- 김범준, "Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea", 대한뇌졸중학회지, 17(1), pp.38~53 (2015), 대한뇌졸중학회
- Sturgeon JD, "Risk factors for intracerebral hemorrhage in a pooled prospective study", Stroke, 38, pp.2718~2725 (2007)
- Kweon S, "Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES)", Int J Epidemiol, 43, pp.69~77 (2014)
- Kelsey J, "Methods in Observational Epidemiology", pp.37~39 (1996), Oxford University Press, Inc
- Daly LE, "Confidence limits made easy: interval estimation using a substitution method", Am J Epidemiol, 147, pp.783~790 (1998)
- Lackland DT, "Factors influencing the decline in stroke mortality: a statement from the American Heart Association", American Stroke Association, 2014, pp.45, 315~353
- Feigin VL, "Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review", Lancet Neurol, 8, pp.355~369 (2009)
- "Annual report on the cause of death statistics"[URL]
- Jee SH, "Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study", JAMA, 282, pp.2149~2155 (1999)
- Jee SH, "Smoking and atherosclerotic cardiovascular disease in women with lower levels of serum cholesterol", Atherosclerosis, 190, pp.306~312 (2007)
- 박태환, "한국인에서 허혈성 뇌졸중에 대한 주요 위험인자들의 인구기여위험도", 대한뇌졸중학회지, 10(2), pp.125~133 (2008), 대한뇌졸중학회
- Hajat C, "Ethnic differences in risk factors for ischemic stroke: a European case-control study", Stroke, 35, pp.1562~1567 (2004)
- Kubo M, "Secular trends in the incidence of and risk factors for ischemic stroke and its subtypes in Japanese population", Circulation, 118, pp.2672~2678 (2008)
- Peters SA, "Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes", Stroke, 44, pp.2821~2828 (2013)
- Kim YS, "Public awareness of stroke in Korea: a population-based national survey", Stroke, 43, pp.1146~1149 (2012)
- Kissela BM, "Epidemiology of ischemic stroke in patients with diabetes: the greater Cincinnati", Northern Kentucky Stroke Study, 2005, pp.28, 355~359
- Almdal T, "The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up", Arch Intern Med, 164, pp.1422~1426 (2004)
- Cui R, "Diabetes mellitus and risk of stroke and its subtypes among Japanese : the Japan public health center study", Stroke, 42, pp.2611~2614 (2011)
- Burn J, "Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project", Stroke, 25, pp.333~337 (1994)
- Hardie K, "Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study", Stroke, 35, pp.731~735 (2004)
- Weimar C, "Discontinuation of antiplatelet study medication and risk of recurrent stroke and cardiovascular events: results from the PRoFESS study", Cerebrovasc Dis, 35, pp.538~543 (2013)
- Go AS, "Heart disease and stroke statistics-2014 update: a report from the American Heart Association", Circulation, 129, pp.e28~e292 (2014)
- Park TH, "Gender differences in the age-stratified prevalence of risk factors in Korean ischemic stroke patients: a nationwide stroke registry-based cross-sectional study", Int J Stroke, 9, pp.759~765 (2014)
- Andersen KK, "The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients", Int J Stroke, 10, pp.99~104 (2015)
- Doehner W, "Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial", Eur Heart J, 34, pp.268~277 (2013)
- Park JM, "Internet-based control recruitment for a case-control study of major risk factors for stroke in Korea: lessons from the experience.", J Stroke Cerebrovasc Dis, 23, pp.2559~2565 (2014)