Περίληψη:
Background: To decide whether a person with certain characteristics
should be given any kind of intervention to prevent a cardiovascular
event, it would be helpful to classify subjects in low, medium and high
risk categories. The study evaluated which well known cerebrovascular
and cardiovascular correlates, in particular fibrinogen level and ECG
characteristics, are able to predict the occurrence of stroke in men of
the general population using data from three European cohorts
participating in EUROSTROKE.
Methods: EUROSTROKE is a collaborative project among ongoing European
population based cohort studies and designed as a prospective nested
case-control study. For each stroke case two controls were sampled.
Strokes were classified according to MONICA criteria or reviewed by a
panel of four neurologists. Complete data were available of 698 men (2
19 stroke events) from cohorts in Cardiff (84 cases/200 controls),
Kuopio (741148) and Rotterdam (61/131). Multivariable logistic
regression modeling was used to evaluate which information from history,
physical examination (for example, blood pressure), blood lipids, and
fibrinogen and ECG measurements independently contributed to the
prediction of stroke. The area under receiver operating characteristic
curve (ROC area) was used to estimate the predictive ability of models.
Results: Independent predictors from medical history and physical
examination were age, stroke history, medically treated hypertension,
smoking, diabetes mellitus and diastolic blood pressure. The ROC area of
this model was 0.69. After validating and transforming this model to an
easy applicable rule, 40% of all future stroke cases could be
predicted. Adding pulse rate, body mass index, blood lipids, fibrinogen
level and ECG parameters did not improve the classification of subjects
in low, medium and high risk. Results were similar when fibrinogen was
dichotomised at the upper tertile or quintile.
Conclusion: In the general male population the future occurrence of
stroke may be predicted using easy obtainable information from medical
history and physical examination. Measurement of pulse rate, body mass
index, blood lipids, fibrinogen level and ECG characteristics do not
contribute to the risk stratification of stroke and have no value in the
screening for stroke in the general male population.
Συγγραφείς:
Moons, KGM
Bots, ML
Salonen, JT
Elwood, PC
de Concalves,
AF
Nikitin, Y
Sivenius, J
Inzitari, D
Benetou, V and
Tuomilehto, J
Koudstaal, PJ
Grobbee, DE
