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Age-related changes in risk factor effects on the incidence of thromboembolic and hemorrhagic stroke
Robert D Abbott1, J David Curb, Beatriz L Rodriguez
1Division of Biostatistics and Epidemiology, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA. rda3e@virginia.edu <rda3e@virginia.edu>
Insights
Risk factor effects on stroke incidence change with age. Hypertension risk for thromboembolic stroke decreases in older men, while physical activity becomes more protective. Lifestyle interventions are crucial for stroke prevention in the elderly.
Area of Science:
- Cardiovascular Epidemiology
- Geriatric Medicine
- Neurology
Background:
- Stroke incidence and risk factor impact vary across age groups.
- Understanding age-related changes in risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate how the effects of major stroke risk factors change with advancing age.
- To analyze longitudinal data on stroke incidence and risk factor status in an aging male population.
Main Methods:
- Utilized data from the Honolulu Heart Program, including repeated risk factor measurements over 26 years.
- Assessed stroke incidence over 6-year follow-up periods for men aged 45-93.
- Analyzed the interaction between age and risk factors like hypertension, diabetes, atrial fibrillation, physical activity, and smoking.
Main Results:
- The risk of thromboembolic stroke associated with hypertension significantly declined with age.
- Physical activity demonstrated an increasing protective effect against stroke as men aged.
- Diabetes and atrial fibrillation consistently increased stroke risk across all age groups.
- Thromboembolic stroke incidence rose with age, irrespective of hypertension or other risk factors, except in cases of atrial fibrillation.
Conclusions:
- Stroke prevention strategies must consider age-dependent modifications in risk factor efficacy.
- Managing diabetes and promoting physical activity in older adults are vital for reducing stroke risk.
- The aging process itself is an independent risk factor for stroke, underscoring the need for continuous risk management.
Abstract:
We examined the changes in risk factor effects on the incidence of thromboembolic and hemorrhagic stroke as they may occur with age. Findings were based on repeated risk factor measurements at four examinations over a 26-year period in 7589 men in the Honolulu Heart Program. After each examination, 6 years of follow-up were available to assess risk factor effects on the incidence of stroke over a broad range of ages (45-93 years). As compared with normotensive men, the risk of thromboembolic stroke in the presence of hypertension declined from a 7-fold excess in men aged 45 to 54 years to a 1.4-fold excess in men aged > or =75 (P<.001). Adverse effects of diabetes and atrial fibrillation seemed to be equally important across all ages, whereas a protective effect of physical activity increased with age. Except for men with atrial fibrillation, the incidence of thromboembolic stroke increased significantly with age regardless of risk factor status, including men with normal blood pressure (P<.001). Although hemorrhagic events were less common, positive relations with cigarette smoking seemed to strengthen with age, whereas those with hypertension tended to decline. Our findings suggest that strategies for the prevention of stroke may need to account for changes in risk factor effects as they occur with age. Control of diabetes and the encouragement of active lifestyles in the elderly seem to be especially important.