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Multiple modifiable risk factors for first ischemic stroke: a population-based epidemiological study
D I Hadjiev1, P P Mineva, M I Vukov
1Medical University, Sofia, Bulgaria. dimiter_hadjiev@hotmail.com
Insights
Over half of Bulgarian urban adults studied had multiple vascular risk factors. Combinations like hypertension with cardiac disease significantly increased stroke and heart attack risks.
Area of Science:
- Epidemiology
- Vascular Health
- Public Health
Background:
- Multiple modifiable vascular risk factors are prevalent in urban populations.
- Understanding their distribution and outcomes is crucial for public health.
- Previous studies have not fully characterized these factors in Bulgarian adults.
Purpose of the Study:
- To determine the prevalence, distribution, and outcomes of multiple modifiable vascular risk factors in a Bulgarian urban population.
- To identify specific risk factor combinations associated with adverse vascular events.
- To inform primary prevention strategies for stroke and cardiovascular disease.
Main Methods:
- Population-based cohort study involving 500 volunteers aged 50-79.
- Data collection included questionnaires, physical examinations, laboratory tests, and carotid duplex scanning.
- Follow-up over 2 years to record transient ischemic attacks (TIAs), ischemic stroke, and myocardial infarction.
Main Results:
- 52% of subjects had three or more modifiable vascular risk factors.
- Hypertension, dyslipidemias, obesity, smoking, and cardiac diseases were most common.
- Asymptomatic carotid stenosis (ACS) was found in 8.8% of those with risk factors.
- Combinations of hypertension and cardiac disease, cardiac disease and obesity, and ACS with high LDL cholesterol were significantly associated with adverse outcomes.
Conclusions:
- Multiple vascular risk factors are highly prevalent in this Bulgarian urban cohort.
- Specific combinations of risk factors significantly increase the risk of major vascular events.
- Identifying individuals with multiple risk factors is vital for targeted primary prevention of stroke and cardiovascular disease.
Abstract:
The aims of this epidemiological population-based cohort study were to examine the prevalence of the multiple modifiable vascular risk factors, their distribution patterns and outcomes among a Bulgarian urban population. A total of 500 volunteers, 200 men and 300 women, without clinical signs and symptoms of cerebrovascular disease, aged 50-79 years, were enrolled in the study. A structured questionnaire, physical examination, electrocardiogram records, a battery of laboratory tests and carotid duplex scanning were employed. Three or more modifiable vascular risk factors were detected in 52% (260/500) of the subjects. Dyslipidemias, hypertension, obesity, cigarette smoking and cardiac diseases were found to be the most prevalent single risk factors. Asymptomatic carotid stenosis (ACS) of 50% or greater was detected in 8.8% (23/260) of the volunteers examined. After a 2-year follow-up, 2.7% (7/260) of the persons with modifiable vascular risk factors reached the end point transient ischemic attacks (TIAs), ischemic stroke and myocardial infarction. The following combinations of risk factors among the subjects enrolled in the study were significantly associated with these outcomes: hypertension and cardiac diseases (OR = 6.82; 95% CI, 1.21-38.41), cardiac diseases and obesity (OR = 6.13; 95% CI, 1.27-29.72), ACS and high low-density lipoprotein (LDL) cholesterol levels (OR = 11.11; 95% CI, 1.58-78.29). The identification of subjects with multiple vascular risk factors may be important for primary medical or surgical stroke prevention.