Slavica Trajkova1, Angelo d'Errico2, Fulvio Ricceri1,2, Francesca Fasanelli1, Valeria Pala3, Claudia Agnoli3, Rosario Tumino4, Graziella Frasca4, Giovanna Masala5, Calogero Saieva5, Paolo Chiodini6, Amalia Mattiello7, Carlotta Sacerdote8, Salvatore Panico7. 1. Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO), Turin, Italy. 2. Unit of Epidemiology, Regional Health Service, Grugliasco, Turin, Italy. 3. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Cancer Registry, Department of Prevention, ASP, Ragusa, Italy. 5. Cancer Risk Factors and Lifestyle Epidemiology Unit Cancer Research and Prevention Institute-ISPO, Florence, Italy. 6. Department of Physical and Mental Health and Prevention, Second University of Naples, Naples, Italy. 7. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. 8. Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO), Turin, Italy. carlotta.sacerdote@cpo.it.
Abstract
OBJECTIVES: The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort. METHODS: 43,976 participants, age 34-75, and free of cardiovascular disease at baseline (1993-1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models. RESULTS: We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4-28%) for smoking and 14% (95% CI 5-22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9-26%) followed by smoking 15% (95% CI 7-22%). Their combination was 46% (95% CI 32-58%) in males and 48% (95% CI 35-59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15-27%) females 9% (95% CI 1-17%)]. CONCLUSIONS: Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.
OBJECTIVES: The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort. METHODS: 43,976 participants, age 34-75, and free of cardiovascular disease at baseline (1993-1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models. RESULTS: We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4-28%) for smoking and 14% (95% CI 5-22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9-26%) followed by smoking 15% (95% CI 7-22%). Their combination was 46% (95% CI 32-58%) in males and 48% (95% CI 35-59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15-27%) females 9% (95% CI 1-17%)]. CONCLUSIONS: Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.
Authors: Larry B Goldstein; Cheryl D Bushnell; Robert J Adams; Lawrence J Appel; Lynne T Braun; Seemant Chaturvedi; Mark A Creager; Antonio Culebras; Robert H Eckel; Robert G Hart; Judith A Hinchey; Virginia J Howard; Edward C Jauch; Steven R Levine; James F Meschia; Wesley S Moore; J V Ian Nixon; Thomas A Pearson Journal: Stroke Date: 2010-12-02 Impact factor: 7.914
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