| Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. | |
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MedLine Citation:
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PMID: 12829866 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To understand the mechanisms of stroke and to target prevention, we need to know how risk factors differ between etiological subtypes. Hospital-based studies may be biased because not all stroke patients are admitted. If risk factors differ between patients who are admitted and those who are not, then case-control studies will be biased. If the likelihood of admission also depends on stroke subtype, then case-case comparisons may also be biased. METHODS: We compared risk factors and ischemic stroke subtypes (TOAST classification) in hospitalized and nonhospitalized patients in 2 population-based stroke incidence studies: the Oxford Vascular Study (OXVASC) and Oxfordshire Community Stroke Project (OCSP). We also performed a meta-analysis of risk factor-stroke subtype associations with other published population-based studies. RESULTS: In OXVASC and OCSP, stroke subtypes differed between hospitalized (293 of 647) and nonhospitalized patients (P<0.0001), with more cardioembolic strokes (odds ratio [OR], 1.8; 95% CI, 1.3 to 2.6) and fewer lacunar strokes (OR, 0.4; 95% CI, 0.3 to 0.7). Premorbid blood pressure and cholesterol were higher in hospitalized patients (both P<0.0001). Risk factor-stroke subtype associations in hospitalized patients were consequently biased (P=0.001). Meta-analysis of data from all patients in OXVASC, OCSP, and 2 other studies demonstrated consistent risk factor-stroke subtype associations. However, contrary to previous hospital-based studies, there was only a weak (OR, 1.4; 95% CI, 1.1 to 1.8) and inconsistent (P(heterogeneity)=0.01) association between small-vessel stroke and hypertension and no association with diabetes (OR, 1.0; 95% CI, 0.7 to 1.3). CONCLUSIONS: Prevalences of risk factors and stroke subtypes differ between hospitalized and nonhospitalized patients with ischemic stroke, which may bias hospital-based risk factor studies. Meta-analysis of population-based studies suggests that vascular risk factors differ between stroke subtypes. |
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Authors:
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U G R Schulz; P M Rothwell |
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Publication Detail:
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Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't Date: 2003-06-26 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 34 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2003 Aug |
Date Detail:
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Created Date: 2003-08-01 Completed Date: 2003-09-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 2050-9 Citation Subset: IM |
Affiliation:
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Stroke Prevention Research Unit, Department of Clinical Neurology, University of Oxford, Oxford OX2 6HE UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Distribution Aged Aged, 80 and over Bias (Epidemiology) Brain Ischemia / classification*, epidemiology* Causality Cohort Studies Comorbidity Female Great Britain / epidemiology Humans Incidence Inpatients / statistics & numerical data Male Middle Aged Odds Ratio Outpatients / statistics & numerical data Prevalence Risk Factors Sex Distribution Stroke / classification*, epidemiology* |
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