Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

BACKGROUND: The treatment of cardiovascular risk factors has improved over the recent years and may have improved survival. The aim of this study was to investigate the up-to-date prognostic significance of cardiovascular risk factors for 5-year survival in a large unselected ischemic stroke population. METHODS: We studied 905 ischemic stroke patients from the community-based Copenhagen Stroke Study. Patients had a CT scan and stroke severity was measured by the Scandinavian Stroke Scale on admission. A comprehensive evaluation was performed by a standardized medical examination and questionnaire for cardiovascular risk factors, age, and sex. Follow-up was performed 5 years after stroke, and data on mortality were obtained for all, except 6, who had left the country. Five-year mortality was calculated by the Kaplan-Meier procedure and the influence of multiple predictors was analyzed by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were associated with decreased mortality. No association was found for hypertension or intermittent claudication. In the final Cox proportional hazard model predictors of 5-year mortality were AF (hazard ratio, HR 1.4; 95% CI 1.1-1.7), diabetes (HR 1.3; 95% CI 1.0-1.6), smoking (HR 1.2; 95% CI 1.0-1.4), and previous stroke (HR 1.4; 95% CI 1.1-1.7), after adjustment for age, gender, and stroke severity. CONCLUSIONS: AF, diabetes, smoking, and previous stroke significantly affect long-term survival. Although smoking and daily alcohol consumption appeared to be associated with improved survival in the univariate analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long-term survival.     

Anger expression and incident stroke: prospective evidence from the Kuopio ischemic heart disease study

BACKGROUND AND PURPOSE: High levels of anger are associated with an increased risk of coronary heart disease and hypertension, but little is known about the role of anger in stroke risk. METHODS: Anger expression style and risk of incident stroke were examined in 2074 men (mean age, 53.0+/-5.2 years) from a population-based, longitudinal study of risk factors for ischemic heart disease and related outcomes in eastern Finland. Self-reported style of anger expression was assessed by questionnaire at baseline. Linkage to the FINMONICA stroke and national hospital discharge registers identified 64 first strokes (50 ischemic) through 1996. Average follow-up time was 8.3+/-0.9 (mean+/-SD) years. RESULTS: Men who reported the highest level of expressed anger were at twice the risk of stroke (relative hazard, 2.03; 95% CI, 1.05 to 3.94) of men who reported the lowest level of anger, after adjustments for age, resting blood pressure, smoking, alcohol consumption, body mass index, low-density and high-density lipoprotein cholesterol, fibrinogen, socioeconomic status, history of diabetes, and use of antihypertensive medications. Additional analysis showed that these associations were evident only in men with a history of ischemic heart disease (n=481), among whom high levels of outwardly expressed anger (high anger-out) predicted >6-fold increased risk of stroke after risk factor adjustment (relative hazard, 6.87; 95% CI, 1.50 to 31.4). Suppressed anger (anger-in) and controlled anger (anger-control) were not consistently related to stroke risk. CONCLUSIONS: This is the first population-based study to show a significant relationship between high levels of expressed anger and incident stroke. Additional research is necessary to explore the mechanisms that underlie this association.     

Improved cardiorespiratory fitness is associated with lower incident ischemic stroke risk: Henry Ford FIT project

BackgroundChange in cardiorespiratory fitness (CRF) modulates vascular disease risk; however, it's unclear if this adds further prognostic information, particularly for ischemic stroke. The objective of this analysis is to describe the association between the change in CRF over time and subsequent incident ischemic stroke.MethodsThis is a retrospective, longitudinal, observational cohort study of 9,646 patients (age=55±11 years; 41% women; 25% black) who completed 2 clinically indicated exercise tests (> 12 months apart) and were free of any stroke at the time of test 2. CRF was expressed as metabolic-equivalents-of-task (METs). Incident ischemic stroke was identified using ICD codes. The adjusted hazard ratio (aHR) was determined for risk of ischemic stroke associated with change in CRF.ResultsMean time between tests was 3.7 years (IQR, 2.2, 6.0). During a median of 5.0 years (IQR, 2.7, 7.6 y) of follow-up, there were 873 (9.1%) ischemic stroke events. Each 1 MET increase between tests was associated with a 9% lower ischemic stroke risk (aHR 0.91 [0.88-0.94]; n = 9.646). There was an interaction effect by baseline CRF category, but not for sex or race. A sensitivity analysis which removed those who experienced an incident diagnosis known to be associated with an increased risk of ischemic vascular disease, validated our primary findings (aHR 0.91 [0.88, 0.95]; n= 6,943).ConclusionsImprovement in CRF over time is independently and inversely associated with a lower risk of ischemic stroke. Encouragement of regular exercise focused on improving CRF may reduce ischemic stroke risk.     

Effect of time since onset of risk factors on the occurrence of ischemic stroke

OBJECTIVE: To determine the effect of time since onset of risk factors on the modeling of risk factors for ischemic stroke. METHODS: The resources of the Rochester Epidemiology Project allowed identification of the 1,397 incident cases of ischemic stroke and age- and sex-matched control subjects from the population for 1970 through 1989. These cases and controls permitted the development of a multiple conditional logistic regression model to estimate the odds ratios of ischemic stroke for various risk factors. The time since onset variables for each risk factor were then added to the model to determine which were significant and to assess their impact on variables in the model. RESULTS: The time since onset variables for congestive heart failure and TIA were the only variables of this type included in the resultant model. Each showed the highest risk for stroke soon after the onset of the risk factor. In addition, the influence of congestive heart failure was higher at younger ages. Hypertension (with or without left ventricular hypertrophy) increases the risk for stroke but has a diminishing influence with increasing age. In addition, persons with left ventricular hypertrophy are at a higher risk than those with hypertension alone, although this difference also decreases with age. The time since onset variables pertaining to systolic hypertension at 140 to 159 mm Hg, 160 to 179 mm Hg, and > or =180 mm Hg were not significant in any analysis. CONCLUSIONS: TIA and congestive heart failure were the only risk factors for stroke for which time since onset was significant in the model for predicting ischemic stroke.     

Do antiphospholipid antibodies increase the long‐term risk of thrombotic complications in young patients with a recent TIA or ischemic stroke?

BACKGROUND: The purpose of our study was to determine the relative risk of thrombotic events in young patients with a recent TIA or ischemic stroke and positive antiphospholipid antibodies (aPL). METHODS: We included 128 consecutive patients aged 18-45 years with a recent TIA or ischemic stroke. All patients underwent computed tomography scanning and were screened for cardiovascular risk factors, cardiac disorders and large vessel disease. Lupus anticoagulant (LA) was screened for by an APTT-based assay and a diluted PT-assay. Anticardiolipin antibodies (aCL) were tested by enzyme-linked immunosorbent assay, using cardiolipin and anti-human IgG and IgM. Thrombotic events could be TIA, stroke, myocardial infarction, deep venous thrombosis or pulmonary embolism. Product limit estimates of the time free of TIA or stroke and of the time free of any thrombotic event were made. The relative risk was estimated by means of a Cox proportional hazards regression model. RESULTS: Of the 128 patients, 22 (17.2%) had aPL. The mean follow-up was 3 years and 3 months (range 41 days to 6 yrs). The incidence of any thrombotic event per 100 patient years of follow-up was 9.0, and the incidence of recurrent stroke or TIA was 7.9. The relative risk of any thrombotic event in patients with aPL was 0.9 (95% CI: 0.3-2.4) and for recurrent ischemic stroke or TIA 0.7 (95% CI: 0.3-2.2). CONCLUSION: In young patients with a recent TIA or ischemic stroke, aPL do not seem to be a strong risk factor for recurrent stroke or TIA, nor for other thrombotic complications.     

Comparison of population-based models of risk factors for TIA and ischemic stroke.

OBJECTIVE: To determine whether there is a difference in the risk factors for ischemic stroke and for TIA. BACKGROUND: TIA is associated with a high risk for ischemic stroke, but some have considered TIA as mild ischemic stroke. Prevention of disabling stroke is sufficient reason to label TIA as a precursor for stroke, but some risk factors may be more or less associated with TIA than with ischemic stroke, suggesting differences in mechanism. METHODS: The medical records linkage system for the Rochester Epidemiology Project provided the means of identifying first episodes of TIA in the Rochester, MN population among those who had not had ischemic stroke. Control subjects were selected from an enumeration of the population through the medical records. The exposure to various risk factors was ascertained. The conditional likelihood approach to estimate the parameters of a multiple logistic model permitted estimation of the OR for TIA for each risk factor while adjusting for confounding variables. RESULTS: The multivariable logistic regression model for TIA shows that the estimates of the ORs for ischemic heart disease, hypertension, persistent atrial fibrillation, diabetes mellitus, and cigarette smoking are similar to the ORs for those variables in the ischemic stroke model. However, the OR for mitral valve disease in the TIA model is 0.4, suggesting that mitral valve disease is unlikely to be associated with cerebral ischemic episodes that are brief enough to be called TIA.     

Classical Risk Factors for Ischemic Stroke are not Associated with Inpatient Post-Stroke Mortality in Sickle Cell Disease

ObjectivesSickle cell disease is a common haemoglobinopathy that significantly increases the risk of ischemic stroke. Because the risk factors for ischemic stroke onset and mortality in non-sickle cell disease patients have been largely elucidated, this paper aims to analyze risk factors for ischemic stroke mortality in sickle cell disease patients, which remain largely unknown.Materials/MethodsThe National Inpatient Sample database (2016–2017) was used to develop a multivariable regression model for risk quantification of known ischemic stroke risk factors for in-hospital mortality in ischemic stroke patients with and without sickle cell disease.ResultsClassical risk factors for ischemic stroke onset, including ischemic heart disease, carotid artery disease, lipidemias, hypertension, obesity, tobacco use, atrial fibrillation, personal or family history of stroke, congenital heart defects, congestive heart failure, cardiac valve disorder, peripheral vascular disease, and diabetes mellitus are associated with in-hospital mortality in non-sickle cell patients (p < 0.05). However, no significant association was found between these stroke risk factors and in-hospital mortality in sickle cell disease patients presenting with ischemic stroke (p > 0.05).ConclusionsWhile the classical risk factors for stroke onset are associated with in-hospital mortality in non-sickle cell stroke patients, they are not associated with in-hospital mortality in sickle cell stroke patients.     

Extreme Gradient Boosting Model Has a Better Performance in Predicting the Risk of 90-Day Readmissions in Patients with Ischaemic Stroke

ObjectIschemic stroke readmission within 90 days of hospital discharge is an important quality of care metric. The readmission rates of ischemic stroke patients are usually higher than those of patients with other chronic diseases. Our aim was to identify the ischemic stroke readmission risk factors and establish a 90-day readmission prediction model for first-time ischemic stroke patients.MethodsThe readmission prediction model was developed using the extreme gradient boosting (XGboost) model, which can generate an ensemble of classification trees and assign a predictive risk score to each feature. The patient data were split into a training set (5159) and a validation set (911). The prediction results were evaluated with the receiver operating characteristic (ROC) curve and time-dependent ROC curve, which were compared with the outputs from the logistic regression (LR) model.ResultsA total of 6070 adult patients (39.6% female, median age 67 years) without any ischemic attack (IS) history were included, and 520 (8.6%) were readmitted within 90 days. The XGboost-based prediction model achieved a standard area under the curve (AUC) value of .782 (.729-.834), and the best time-dependent AUC value was .808 in 54 days for the validation set. In contrast, the LR model yielded a standard AUC value of .771 (.714-.828) and best time-dependent AUC value of .797.ConclusionsThe XGboost model obtained a better risk prediction for 90-day readmission for first-time ischemic stroke patients than the LR model. This model can also reveal the high risk factors for stroke readmission in first-time ischemic stroke patients.     

Hyperhomocyst(e)inemia is a risk factor of secondary vascular events in stroke patients

OBJECTIVE: Moderate hyperhomocyst(e)inemia is an independent risk factor for stroke, but it is unclear whether it also would be a risk factor for secondary vascular events after stroke. METHODS: Longitudinal study of 137 consecutive ischemic stroke patients (age 45-91 years) who were prospectively studied with a standard clinical protocol. Vascular events (stroke recurrence, ischemic heart disease, deep venous thrombosis or peripheral arterial disease) were identified during 2 years of follow-up. Serum homocyst(e)ine was determined 3 months after the stroke. The cumulative proportion of patients with homocyst(e)ine above or below the 75th percentile who survived free of vascular events was determined by Kaplan-Meier analysis. Cox models were used to estimate the relative risk of vascular events after controlling for other confounding factors. RESULTS: Serum homocyst(e)ine was significantly higher in patients with vascular events (26.2 versus 19.4 micromol/l; p = 0.016). The cumulative proportion of patients with vascular events was 46.5% in the group with homocyst(e)ine over the 75th percentile (>30 micromol/l) and 20.2% in the other group (log-rank test 7.5; p = 0.0062). After adjustment for age, sex, high blood pressure, diabetes, heart disease, previous cerebrovascular disease, smoking and serum cholesterol, the relative risk of vascular event for patients above compared with those below the 75th percentile of serum homocyst(e)ine was 2.8 (CI 95% 1.3-6; p = 0.01). CONCLUSION: Hyperhomocyst(e)inemia is a significant risk factor for vascular events after ischemic stroke. This finding is independent of other risk factors such as hypertension, and may have therapeutic relevance in the secondary prevention of vascular diseases in stroke patients.     

Cardiovascular risk factors in patients aged 85 or older with ischemic stroke

OBJECTIVES: To define a cardiovascular risk factor profile in very old patients with ischemic stroke. PATIENTS AND METHODS: Data from a prospective hospital-based stroke registry was collected. Demographic characteristics and cardiovascular risk factors in individuals aged 85 years or older with ischemic stroke (n=303) were compared with patients under 85 years (n=1537). RESULTS: The study population accounted for 16.5% of all cases of ischemic stroke. The mean (S.D.) age was 88.2 (2.8) years (70% women). Hypertension occurred in 44.9% of patients, atrial fibrillation in 42.6%, diabetes in 16.2%, and congestive heart failure in 15.5%. The most frequent stroke subtypes were cardioembolic (36%) and atherothrombotic (31.4%) infarction. Congestive heart failure (odds ratio [OR]=3.62), chronic renal disease (OR=2.54), female sex (OR=2.27), previous cerebrovascular disease (OR=1.71), and atrial fibrillation (OR=1.38) were significantly associated with ischemic stroke, whereas diabetes (OR=0.68), hypertension (OR=0.61), hyperlipidemia (OR=0.45), and heavy smoking (OR=0.21) occurred more frequently in patients under 85 years. CONCLUSION: Adequate treatment of potentially modifiable risk factors, including congestive heart failure, chronic renal disease, and atrial fibrillation may contribute to prevent ischemic stroke in very old people.     

Risk factors and treatment outcomes for children with arterial ischemic stroke

To investigate the risk factors and treatment outcomes for ischemic stroke in children, we reviewed the charts of 93 children with ischemic stroke seen at our hospital between 1997 and 2006. Age at stroke, sex, medical history, family history, clinical findings upon admission, history of seizure, and radiological findings were recorded. Mean age at onset of the initial stroke was 56.6 ± 46.9 months, ranging from 1 month to 14 years. The male:female ratio was 1.6:1. Cardiac and infectious disease were the most common risk factors (37.7%). There were five children (5.4%) who had recurrent stroke and three (3.2%) who had multiple risk factors. Cardiac and infectious causes appeared to be the most important risk factors for ischemic stroke in children in the Adana region of Turkey.     

Differences between hypertensive and non-hypertensive ischemic stroke

We compared risk factors, clinical features, neuroimaging data, and outcome between hypertensive and non-hypertensive ischemic stroke patients. Differential features of ischemic stroke patients with hypertension (n = 768) and without hypertension (n = 705) were assessed by bivariate analysis. Independent predictors of hypertensive ischemic stroke were determined by multivariate analysis. Atherothrombotic infarction and lacunar infarct were significantly more common in the hypertensive group, in which older age and a higher occurrence of previous cerebral infarction, hyperlipidemia, acute stroke onset, lacunar syndrome, and pons topography was also observed. Age of 85 years or older, valvular heart disease, and decreased consciousness were more common in non-hypertensive patients. After multivariate analysis, lacunar syndrome, female gender, and previous infarction were directly associated with hypertensive ischemic stroke. Age of 85 years or older and valvular heart disease were inversely associated with hypertensive ischemic stroke. Hypertension was the main cardiovascular risk factor only for lacunes and atherothrombotic infarction, that is, ischemic stroke associated with small- and large-artery disease.     

Prospective study of Chlamydia pneumoniae IgG and IgA seropositivity and risk of incident ischemic stroke

BACKGROUND AND PURPOSE: Chlamydia pneumoniae infection or exposure to C. pneumoniae was implicated as a risk factor for ischemic stroke. Our aim was to evaluate prospectively the association between the presence of antibodies to C. pneumoniae (IgG and IgA) and the risk of incident ischemic stroke among patients with pre-existing vascular disease. METHODS: Sera were collected from 3,090 coronary heart disease patients enrolled in a secondary prevention trial. We measured baseline antibodies (IgG and IgA) in the sera of patients who developed subsequent ischemic strokes (cases, n = 134) during follow-up (mean 8.2 years), and in 134 age- and gender-matched pairs without subsequent stroke or myocardial infarction. RESULTS: The crude relative odds (95%CI) of incident ischemic strokes in seropositive patients at baseline (>1.1 relative value units) were 1.29 (95%CI, 0.69-2.47) for IgG and 1.31 (95% CI, 0.69-2.55) for IgA by matched-pair analyses, and 1.42 (95%CI, 0.69-2.98) for IgG and 1.57 (95%CI, 0.76-3.35) for IgA after adjustments for conventional risk factors and the inflammatory marker, soluble intercellular adhesion molecule-1. We explored the possibility that the risk of ischemic stroke may increase in parallel to increasing antibody titers, but did not demonstrate any significant association. CONCLUSIONS: Serological evidence for prior infection with C. pneumoniae did not emerge as an independent risk factor for incident ischemic stroke among patients at high risk due to pre-existing vascular disease.     

Mortality in patients with dementia after ischemic stroke

OBJECTIVE: Although dementia is typically considered to be a consequence of a variety of neurologic diseases, it can also serve as a risk factor for other adverse outcomes. The authors investigated dementia as a predictor of long-term survival among patients with ischemic stroke. METHODS: Neurologic, neuropsychological, and functional assessments were administered to 453 patients (mean age +/- SD, 72.0 +/- 8.3 years) 3 months after ischemic stroke. The authors diagnosed dementia in 119 (26.3%) of the patients using modified Diagnostic and Statistical Manual of Mental Disorders, Revised 3rd Edition, criteria requiring deficits in memory and two or more additional cognitive domains as well as functional impairment. Dementia as a predictor of long-term survival during up to 10 years of follow-up was then investigated. RESULTS: The mortality rate was 15.90 deaths per 100 person-years among patients with dementia and 5.37 deaths per 100 person-years among nondemented patients. A Cox proportional hazards analysis found that the relative risk (RR) of death was increased in association with dementia (RR = 2.4; 95% CI = 1.6 to 3.4), adjusting for the following: a major hemispheral stroke syndrome (RR = 1.4); a middle cerebral artery territory index stroke (RR = 1.7); a Stroke Severity Scale score of > or = 4, representing more severe stroke (RR = 1.8); atrial fibrillation (RR = 1.8); congestive heart failure (RR = 2.2); recurrent stroke occurring during follow-up (RR = 3.9); and demographic variables. The risk of death increased in association with the severity of dementia, but it did not differ by dementia subtype. CONCLUSIONS: Dementia is a significant independent risk factor for reduced survival after ischemic stroke, adjusting for other recognized predictors of mortality. The authors hypothesize that patients with dementia are at an elevated risk of mortality because of their increased burden of cerebrovascular disease, a tendency toward undertreatment for stroke prophylaxis among clinicians, or patient noncompliance with treatment regimens.     

Risk Factors for Pressure Sores in Hospitalized Acute Ischemic Stroke Patients

BackgroundAcute ischemic stroke patients are a group at high risk for pressure sores. It is important to identify risk factors for pressure sores in acute ischemic stroke patients in order to facilitate early adoption of appropriate preventive and treatment measures.MethodsData were derived from the China National Stroke Registry. Acute ischemic stroke patients aged >18 years who presented at the hospital within 14 days after the onset of symptoms were eligible for this study. Comprehensive baseline data were collected. The definition of pressure sores was based on assessment at discharge of whether the patient had pressure sores at any time during hospitalization.Results12,415 patients with a mean age of 67 years and a mean length of hospitalization of 14 days were included in the study. Among these patients, 97 (0.8%) had pressure sores during hospitalization. In the multivariate analysis of risk factors for pressure sores, age (each increment of 5 years), being unmarried, NIHSS at admission (each increment of 3 points), mRS at admission (3-5 points), diabetes mellitus, hemoglobin at admission (each incremental reduction of 10 units), and history of peripheral vascular disease all were significantly correlated with the occurrence of pressure sores among acute ischemic stroke patients during hospitalization.ConclusionsOld age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease were risk factors for pressure sores in acute ischemic stroke patients.     

Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: A prospective hospital-based study in Asia. Asian Acute Stroke Advisory Panel.

BACKGROUND AND PURPOSE: In Asia, there has been no international study to investigate the risk factors for early death in patients with ischemic stroke and intracerebral hemorrhage. METHODS: We conducted a prospective study of consecutive patients with acute stroke who were admitted to 36 participating hospitals in China, India, Indonesia, Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. With the use of a simple identical data sheet, we recorded the demographics and cardiovascular risk factors of each patient. Early death was defined as death on discharge from the acute hospital. RESULTS: We enrolled 2403 patients with ischemic stroke and 783 patients with intracerebral hemorrhage. Among patients with ischemic stroke, previous use of antiplatelet drugs (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI] 0. 30 to 0.95) and relatively young age group 56 to 75 years (OR 0.65; 95% CI 0.42 to 1.00) were protective factors; atrial fibrillation (OR 2.23; 95% CI 1.40 to 3.57), ischemic heart disease (OR 2.03; 95% CI 1.37 to 3.05), diabetes (OR 1.52; 95% CI 1.04 to 2.22), and ex-smoker status (OR 2.18; 95% CI 1.18 to 4.05) were risk factors for early death. Among patients with intracerebral hemorrhage, hypertension (OR 0.56; 95% CI 0.38 to 0.82) and young age group 56 to 75 years old (OR 0.55; 95% CI 0.34 to 0.87) were associated with lower death rate, whereas diabetes (OR 1.74; 95% CI 1.01 to 2.98) was a risk factor for early death. CONCLUSIONS: In Asian patients with stroke, previous use of antiplatelet drugs nearly halved the risk of early death in patients with ischemic stroke, whereas atrial fibrillation, ischemic heart disease, diabetes, and ex-smoker status were risk factors for early death. Among patients with intracerebral hemorrhage, diabetes was associated with early death, whereas young age group and hypertension were associated with lower death rates, though no clear explanation for the hypertension association could be discerned from the data available.     

缺血性脑卒中复发危险因素及干预的探讨

目的 进一步探讨缺血性脑卒中复发危险因素和干预措施。方法对525例缺血性脑卒中在院患者(复发组110例，对照组415例)的临床资料进行回顾性分析。结果发现在高血压、糖尿病、高血脂、冠心病、吸烟、饮酒及脑卒中家族史等危险因素方面。复发组与对照组比较无显著性差异。另发现在复发组中，合并高血压、高脂血症患者应降压调脂而未坚持降压、调脂或治疗不规则的患者；未或未坚持用抗血小板聚集药物治疗的患者；首次卒中后未或未坚持康复治疗者缺血性脑卒中复发所占百分率较高。结论充分认识和积极干预缺血性脑卒中复发的危险因素，对于预防复发十分重要。     

History of blood transfusion before 1990 is a risk factor for stroke and cardiovascular diseases: the Japan collaborative cohort study (JACC study)

BACKGROUND: We have previously shown novel evidence that history of blood transfusion is a risk factor for mortality from subarachnoid hemorrhage. This study was conducted to assess history of transfusion as a risk factor for other hemorrhagic stroke or ischemic stroke and cardiovascular diseases. STUDY DESIGN AND METHODS: A total of 88,312 Japanese participants (36,823 men and 51,489 women), aged 40-79 years, without history of stroke, heart disease or cancer, completed a questionnaire including history of transfusion under the JACC Study from 1988 to 1990. Participants were followed up annually until deceased, or when they moved away from the surveyed community, or at the end of 1999. The underlying causes of death were determined according to the International Classification of Diseases, 10th revision (ICD-10). RESULTS: Total follow-up person-years were 871,437 (males 359,437, females 512,000). During this 10-year period, 309 died from intracerebral hemorrhage, 587 from ischemic stroke and 472 from coronary heart disease. The multivariate relative risks of a transfusion history were 2.16 (95% CI 1.42-3.27, p < 0.001) for intracerebral hemorrhage, 1.63 (95% CI 1.18-2.27, p = 0.004) for ischemic stroke and 1.66 (95% CI 1.17-2.36, p = 0.005) for coronary heart disease, after adjustment for conventional cardiovascular risk factors. CONCLUSION: A transfusion history was associated with increased mortality from stroke and coronary heart disease.     

Blood pressure in acute stroke. The Copenhagen Stroke Study

This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. BP declined with increasing time from stroke onset with a total of 8/4 mm Hg. Independent factors related to diastolic BP were ischemic heart disease (-3.9 mm Hg), male gender (2.2 mm Hg), known hypertension prior to stroke (8.6 mm Hg), and primary hemorrhage (9.7 mm Hg). Independent factors related to systolic BP were age (3.6 mm Hg/10-year increase), atrial fibrillation (-7.2 mm Hg), ischemic heart disease (-6.0 mm Hg), intracerebral hemorrhage (13.3 mm Hg), and known hypertension prior to stroke (16.3 mm Hg). No independent relations were seen between BP and diabetes, claudication, previous stroke, smoking, daily alcohol consumption, initial stroke severity and lesion size. The increase in BP in the acute phase of stroke is a uniform response to the ischemic event per se. BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.