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Scoring system to identify men at high risk of stroke: a strategy for general practice
W G Coppola1, P H Whincup, O Papacosta
1University Department of Public Health, Royal Free Hospital School of Medicine, London.
Insights
A new scoring system accurately identifies men aged 40-59 at high risk of stroke using age, blood pressure, smoking, and chest pain. This tool aids general practice in targeted stroke prevention interventions.
Area of Science:
- Cardiovascular Health
- Preventive Medicine
- Epidemiology
Background:
- Major stroke risk factors like hypertension and smoking are modifiable.
- Efficient disease prevention requires identifying individuals at high risk of stroke.
- A practical system for high-risk detection is needed in general practice.
Purpose of the Study:
- To design an effective and practical system for detecting high-risk stroke individuals.
- Focus on men aged 40 to 59 years in primary care settings.
Main Methods:
- Analyzed stroke incidence and risk factor data from 7735 men (aged 40-59) in the British regional heart study.
- Utilized data from initial entry and 5 and 11.5-year follow-ups.
- Data sourced from general practices across 24 UK towns with varied cardiovascular mortality rates.
Main Results:
- A logistic regression-derived scoring system using age, systolic blood pressure, smoking, and anginal chest pain detected over 80% of strokes within five years in the top risk quintile.
- Including additional risk factors did not improve the score's predictive power.
- Combined smoking and hypertension were better stroke risk indicators than single factors, though less sensitive than the scoring system.
Conclusions:
- The developed scoring system, based on easily measured variables, can identify high-risk men in general practice for targeted interventions.
- Effective identification of high-risk individuals necessitates assessing the combined impact of multiple risk factors.
Background:
The major risk factors for stroke are well described and there is good evidence that the risks associated with hypertension and cigarette smoking are reversible by appropriate interventions. However, if disease prevention measures are to be efficient, it is important that a system which can identify individuals at high risk of stroke be available for use in general practice.
Aim:
A study was therefore undertaken to design an effective and practical system for detecting men aged 40 to 59 years at high risk of stroke in primary care.
Method:
Stroke incidence and risk factor data were examined in a cohort of 7735 men aged 40 to 59 years who had taken part in the British regional heart study. Analysis was performed using data from initial entry into the study and then from five and 11.5 years of follow up. Subjects were randomly selected from the age-sex register of one general practice in each of 24 different towns throughout the United Kingdom, representing the full range of cardiovascular mortality rates.
Results:
A simple scoring system derived from logistic regression using age, systolic blood pressure, current cigarette consumption, and evidence of anginal chest pain was able to detect more than 80% of all strokes occurring within five years in the top fifth of the score distribution. The inclusion of other risk factors for stroke did not increase the score's predictive ability. The combination of smoking and hypertension, while much less sensitive than the scoring system, was a better indicator of risk than any single risk factor, all of whose predictive values were poor.
Conclusion:
Based on readily measured variables, this scoring system could be used in general practice to identify men at high risk of stroke who would benefit from further intervention. Effective identification of high risk individuals requires assessment of the combined effects of multiple risk factors.