Marileen L P Portegies1,2, Lies Lahousse1,3, Guy F Joos3, Albert Hofman1, Peter J Koudstaal2, Bruno H Stricker1,4, Guy G Brusselle1,5,3, M Arfan Ikram1,2,6. 1. 1 Department of Epidemiology. 2. 2 Department of Neurology. 3. 3 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium. 4. 4 Department of Internal Medicine. 5. 5 Department of Respiratory Medicine, and. 6. 6 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; and.
Abstract
RATIONALE: Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD. OBJECTIVES: To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations. METHODS: Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model. MEASUREMENTS AND MAIN RESULTS: COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00-1.43), ischemic stroke (HR, 1.27; 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 1.01-2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91-1.31) for all stroke; HR, 1.13 (0.91-1.42) for ischemic stroke; and HR 1.53 (0.91-2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42-18.20) increased risk of stroke. CONCLUSIONS: Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
RATIONALE: Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD. OBJECTIVES: To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations. METHODS: Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model. MEASUREMENTS AND MAIN RESULTS:COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00-1.43), ischemic stroke (HR, 1.27; 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 1.01-2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91-1.31) for all stroke; HR, 1.13 (0.91-1.42) for ischemic stroke; and HR 1.53 (0.91-2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42-18.20) increased risk of stroke. CONCLUSIONS: Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
Authors: Tadahiro Goto; Yuichi J Shimada; Mohammad Kamal Faridi; Carlos A Camargo; Kohei Hasegawa Journal: J Gen Intern Med Date: 2018-06-08 Impact factor: 5.128
Authors: M Arfan Ikram; Guy G O Brusselle; Sarwa Darwish Murad; Cornelia M van Duijn; Oscar H Franco; André Goedegebure; Caroline C W Klaver; Tamar E C Nijsten; Robin P Peeters; Bruno H Stricker; Henning Tiemeier; André G Uitterlinden; Meike W Vernooij; Albert Hofman Journal: Eur J Epidemiol Date: 2017-10-24 Impact factor: 8.082
Authors: Surya P Bhatt; Ella A Kazerooni; John D Newell; John E Hokanson; Matthew J Budoff; Chandra A Dass; Carlos H Martinez; Sandeep Bodduluri; Francine L Jacobson; Andrew Yen; Mark T Dransfield; Carl Fuhrman; Hrudaya Nath Journal: Chest Date: 2018-06-08 Impact factor: 9.410
Authors: Victoria Austin; Peter J Crack; Steven Bozinovski; Alyson A Miller; Ross Vlahos Journal: Clin Sci (Lond) Date: 2016-07-01 Impact factor: 6.124