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Relative role of factors associated with cerebral infarction and cerebral hemorrhage. A matched pair case-control
Insights
Hypertension is a key risk factor for both stroke types. Stroke infarction is also linked to diabetes, heart issues, and smoking, sharing risk factors with ischemic heart disease.
Area of Science:
- Neurology
- Epidemiology
- Cardiovascular Medicine
Background:
- Stroke is a major cause of death and disability.
- Identifying risk factors is crucial for stroke prevention.
Purpose of the Study:
- To identify and analyze risk factors for stroke infarction and hemorrhage.
- To compare risk factors between stroke subtypes and controls.
Main Methods:
- Case-control study design using hospital admission data from Winnipeg, Manitoba (1970-1971).
- Ascertainment of 606 stroke cases and matching with 606 controls.
- Review of medical records, death certificates, and autopsy reports.
Main Results:
- Hypertension identified as a primary risk factor for both stroke infarction and hemorrhage.
- Additional risk factors for infarction include diabetes, cardiomegaly, ECG abnormalities, and smoking.
- Infarction shares risk factors with ischemic heart disease, including medication history and prior myocardial infarction.
Conclusions:
- Hypertension is a significant risk factor for hemorrhagic and infarctive stroke.
- Stroke infarction shares common risk factors with ischemic heart disease.
- Certain factors, like elevated hemoglobin/hematocrit at admission, may be secondary to stroke rather than causative.
Abstract:
Comprehensive ascertainment of all possible new cases of stroke appearing between January 1, 1970 and June 30, 1971, and admitted to three major hospitals in Winnipeg, Manitoba, has been achieved by reviewing the Manitoba Health Services Commission claim reports. The medical records of these cases were reviewed, pertinent data were abstracted, and rigid criteria for diagnosis were followed. Also, data were obtained from death certificates, autopsy reports and long-term hospital records. A total of 606 ascertained cases (410 infarction, 137 hemorrhage, and 59 undetermined type) were matched for age, sex, residence and year of admission with 606 controls from admissions for other than cardiovascular and cerebrovascular disorders. The data were analyzed for elucidating the possible risk factors for infarction (INF) and hemorrhage (HGE). The findings suggested that hypertension was the main risk factor in hemorrhage, whereas in infarction, along with hypertension, other factors such as diabetes, heart enlargement in chest x-ray, ECG abnormalities, and smoking were suggested as risk factors. There was an association also between infarction, on one hand, and the history of receiving anticoagulants, diuretics, and medications for the heart, and the occurrence of myocardial infarction, on the other hand. These features indicate that infarction and ischemic heart disease have similar risk factors. Hemoglobin and hematocrit were higher in infarction cases than in their controls only when measured at stroke admission. No difference was revealed when they were measured prior to stroke. Their association with infraction therefore may be secondary to other factors and of no significance for its risk.