Stroke incidence and association with risk factors in women: a 32-year follow-up of the Prospective Population Study of Women in Gothenburg

Objective To study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors. Design Prospective population study initiated in 1968–1969 with follow-ups in 1974, 1980, 1992 and 2001. Setting Gothenburg,...

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Bibliographic Details
Published in:BMJ open 2014-01, Vol.4 (10), p.e005173-e005173
Main Authors: Blomstrand, Ann, Blomstrand, Christian, Ariai, Nashmil, Bengtsson, Calle, Björkelund, Cecilia
Format: Article
Language:English
Subjects:
Adult
Age
Aged
Aged, 80 and over
Allmän medicin
Body Mass Index
Brain Ischemia - complications
Brain Ischemia - epidemiology
Cardiovascular Medicine
Cerebral Hemorrhage - complications
Cerebral Hemorrhage - epidemiology
Classification
Education
Educational Status
Family Medicine
Female
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Humans
Hypertension
Hypertension - epidemiology
Incidence
Lifestyles
Longitudinal Studies
Medical records
Middle Aged
Mortality
Multivariate Analysis
Overweight - epidemiology
Population
Prospective Studies
Public Health, Global Health, Social Medicine and Epidemiology
Risk Factors
Sedentary Behavior
Smoking - epidemiology
Socioeconomic factors
Stroke
Stroke - epidemiology
Stroke - etiology
Studies
Sweden - epidemiology
Triglycerides
Women
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Summary:Objective To study stroke incidence among women over 32 years of age with a focus on subdividing by stroke type, to consolidate end points and associations with risk factors. Design Prospective population study initiated in 1968–1969 with follow-ups in 1974, 1980, 1992 and 2001. Setting Gothenburg, Sweden. Participants A sample of 1462 women from five age strata examined in 1968–1969, representative of women in the general population. Main outcome measures Main types of first-ever stroke and fatal stroke during 1968–2001 identified and validated. Stroke incidence rates in different age strata. Association with baseline smoking, body mass index (BMI), waist–hip ratio, hypertension, serum lipids, physical inactivity, perceived mental stress and education. Associations with atrial fibrillation (AF), diabetes, baseline hypertension and myocardial infarction (MI). Blood pressure (BP) levels 1–3, corresponding to modern guidelines, in relation to stroke risk. Results 184 (12.6%) cases of first-ever stroke, 33 (18%) of them fatal. Validation reduced unspecified stroke diagnoses from 37% to 11%. Age-standardised incidence rate per 100 000 person-years was 448. A multivariate model showed a significant association between ischaemic stroke and high BMI: HR 1.07 (95% CI 1.02 to 1.12), smoking 1.78 (1.23 to 2.57) and low education 1.17 (1.01 to 1.35). Significant association was seen between haemorrhagic stroke and, besides age, physical inactivity 2.18 (1.04 to 4.58) and for total stroke also hypertension 1.45 (1.02 to 2.08). Survival analysis showed a significantly increased risk of stroke in participants with diabetes (p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2014-005173