Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Stroke | Research

Comparison of risk factors for ischemic stroke and coronary events in a population-based cohort

Authors: Iram Faqir Muhammad, Yan Borné, Suneela Zaigham, Martin Söderholm, Linda Johnson, Margaretha Persson, Olle Melander, Gunnar Engström

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Login to get access

Abstract

Background

Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes.

Method

Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes.

Results

Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE.

Conclusion

CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.
Appendix
Available only for authorised users
Literature
2.
go back to reference Soler EP, Ruiz VC. Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences. Curr Cardiol Rev. 2010;6(3):138–49.CrossRef Soler EP, Ruiz VC. Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences. Curr Cardiol Rev. 2010;6(3):138–49.CrossRef
3.
go back to reference Collaboration PS. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet (London, England). 1995;346(8991–8992):1647–53. Collaboration PS. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet (London, England). 1995;346(8991–8992):1647–53.
4.
go back to reference Bowman TS, Sesso HD, Ma J, Kurth T, Kase CS, Stampfer MJ, Gaziano JM. Cholesterol and the risk of ischemic stroke. Stroke. 2003;34(12):2930–4.CrossRef Bowman TS, Sesso HD, Ma J, Kurth T, Kase CS, Stampfer MJ, Gaziano JM. Cholesterol and the risk of ischemic stroke. Stroke. 2003;34(12):2930–4.CrossRef
5.
go back to reference Bots ML, Elwood PC, Nikitin Y, Salonen JT, Freire de Concalves A, Inzitari D, Sivenius J, Benetou V, Tuomilehto J, Koudstaal PJ, et al. Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe. J Epidemiol Commun Health. 2002;56(Suppl 1):i19–24.CrossRef Bots ML, Elwood PC, Nikitin Y, Salonen JT, Freire de Concalves A, Inzitari D, Sivenius J, Benetou V, Tuomilehto J, Koudstaal PJ, et al. Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe. J Epidemiol Commun Health. 2002;56(Suppl 1):i19–24.CrossRef
6.
go back to reference Stoekenbroek RM, Boekholdt SM, Luben R, Hovingh GK, Zwinderman AH, Wareham NJ, Khaw KT, Peters RJ. Heterogeneous impact of classic atherosclerotic risk factors on different arterial territories: the EPIC-Norfolk prospective population study. Eur Heart J. 2016;37(11):880–9.CrossRef Stoekenbroek RM, Boekholdt SM, Luben R, Hovingh GK, Zwinderman AH, Wareham NJ, Khaw KT, Peters RJ. Heterogeneous impact of classic atherosclerotic risk factors on different arterial territories: the EPIC-Norfolk prospective population study. Eur Heart J. 2016;37(11):880–9.CrossRef
7.
go back to reference Sigala F, Oikonomou E, Antonopoulos AS, Galyfos G, Tousoulis D. Coronary versus carotid artery plaques. Similarities and differences regarding biomarkers morphology and prognosis. Curr Opin Pharmacol. 2018;39:9–18.CrossRef Sigala F, Oikonomou E, Antonopoulos AS, Galyfos G, Tousoulis D. Coronary versus carotid artery plaques. Similarities and differences regarding biomarkers morphology and prognosis. Curr Opin Pharmacol. 2018;39:9–18.CrossRef
8.
go back to reference Kannel WB, D’Agostino RB, Sullivan L, Wilson PW. Concept and usefulness of cardiovascular risk profiles. Am Heart J. 2004;148(1):16–26.CrossRef Kannel WB, D’Agostino RB, Sullivan L, Wilson PW. Concept and usefulness of cardiovascular risk profiles. Am Heart J. 2004;148(1):16–26.CrossRef
9.
go back to reference Giang KW, Bjorck L, Novak M, Lappas G, Wilhelmsen L, Toren K, Rosengren A. Stroke and coronary heart disease: predictive power of standard risk factors into old age–long-term cumulative risk study among men in Gothenburg, Sweden. Eur Heart J. 2013;34(14):1068–74.CrossRef Giang KW, Bjorck L, Novak M, Lappas G, Wilhelmsen L, Toren K, Rosengren A. Stroke and coronary heart disease: predictive power of standard risk factors into old age–long-term cumulative risk study among men in Gothenburg, Sweden. Eur Heart J. 2013;34(14):1068–74.CrossRef
10.
go back to reference Glynn RJ, Rosner B. Methods to evaluate risks for composite end points and their individual components. J Clin Epidemiol. 2004;57(2):113–22.CrossRef Glynn RJ, Rosner B. Methods to evaluate risks for composite end points and their individual components. J Clin Epidemiol. 2004;57(2):113–22.CrossRef
11.
go back to reference Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol. 2005;162(10):975–82.CrossRef Glynn RJ, Rosner B. Comparison of risk factors for the competing risks of coronary heart disease, stroke, and venous thromboembolism. Am J Epidemiol. 2005;162(10):975–82.CrossRef
12.
go back to reference Wilhelmsen L, Koster M, Harmsen P, Lappas G. Differences between coronary disease and stroke in incidence, case fatality, and risk factors, but few differences in risk factors for fatal and non-fatal events. Eur Heart J. 2005;26(18):1916–22.CrossRef Wilhelmsen L, Koster M, Harmsen P, Lappas G. Differences between coronary disease and stroke in incidence, case fatality, and risk factors, but few differences in risk factors for fatal and non-fatal events. Eur Heart J. 2005;26(18):1916–22.CrossRef
13.
go back to reference Manjer J, Carlsson S, Elmstahl S, Gullberg B, Janzon L, Lindstrom M, Mattisson I, Berglund G. The Malmo Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev. 2001;10(6):489–99.CrossRef Manjer J, Carlsson S, Elmstahl S, Gullberg B, Janzon L, Lindstrom M, Mattisson I, Berglund G. The Malmo Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev. 2001;10(6):489–99.CrossRef
14.
go back to reference Zia E, Melander O, Bjorkbacka H, Hedblad B, Engstrom G. Total and differential leucocyte counts in relation to incidence of stroke subtypes and mortality: a prospective cohort study. J Intern Med. 2012;272(3):298–304.CrossRef Zia E, Melander O, Bjorkbacka H, Hedblad B, Engstrom G. Total and differential leucocyte counts in relation to incidence of stroke subtypes and mortality: a prospective cohort study. J Intern Med. 2012;272(3):298–304.CrossRef
15.
go back to reference Hedblad B, Nilsson P, Janzon L, Berglund G. Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmo, Sweden. Diabetic Med. 2000;17(4):299–307.CrossRef Hedblad B, Nilsson P, Janzon L, Berglund G. Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmo, Sweden. Diabetic Med. 2000;17(4):299–307.CrossRef
16.
go back to reference Frondelius K, Borg M, Ericson U, Borne Y, Melander O, Sonestedt E. Lifestyle and dietary determinants of serum apolipoprotein A1 and apolipoprotein B concentrations: cross-sectional analyses within a Swedish Cohort of 24,984 individuals. Nutrients. 2017;9(3):211. Frondelius K, Borg M, Ericson U, Borne Y, Melander O, Sonestedt E. Lifestyle and dietary determinants of serum apolipoprotein A1 and apolipoprotein B concentrations: cross-sectional analyses within a Swedish Cohort of 24,984 individuals. Nutrients. 2017;9(3):211.
17.
go back to reference Enhörning S, Sjögren M, Hedblad B, Nilsson PM, Struck J, Melander O. Genetic vasopressin 1b receptor variance in overweight and diabetes mellitus. Eur J Endocrinol. 2016;174(1):69–75.CrossRef Enhörning S, Sjögren M, Hedblad B, Nilsson PM, Struck J, Melander O. Genetic vasopressin 1b receptor variance in overweight and diabetes mellitus. Eur J Endocrinol. 2016;174(1):69–75.CrossRef
18.
go back to reference Muhammad IF, Borne Y, Hedblad B, Nilsson PM, Persson M, Engstrom G. Acute-phase proteins and incidence of diabetes: a population-based cohort study. Acta Diabetol. 2016;53(6):981–9.CrossRef Muhammad IF, Borne Y, Hedblad B, Nilsson PM, Persson M, Engstrom G. Acute-phase proteins and incidence of diabetes: a population-based cohort study. Acta Diabetol. 2016;53(6):981–9.CrossRef
19.
go back to reference Persson M, Ostling G, Smith G, Hamrefors V, Melander O, Hedblad B, Engstrom G. Soluble urokinase plasminogen activator receptor: a risk factor for carotid plaque, stroke, and coronary artery disease. Stroke. 2014;45(1):18–23.CrossRef Persson M, Ostling G, Smith G, Hamrefors V, Melander O, Hedblad B, Engstrom G. Soluble urokinase plasminogen activator receptor: a risk factor for carotid plaque, stroke, and coronary artery disease. Stroke. 2014;45(1):18–23.CrossRef
20.
go back to reference Jerntorp P, Berglund G. Stroke registry in Malmo, Sweden. Stroke. 1992;23(3):357–61.CrossRef Jerntorp P, Berglund G. Stroke registry in Malmo, Sweden. Stroke. 1992;23(3):357–61.CrossRef
21.
go back to reference Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRef Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRef
22.
go back to reference Lunn M, McNeil D. Applying Cox regression to competing risks. Biometrics. 1995;51(2):524–32.CrossRef Lunn M, McNeil D. Applying Cox regression to competing risks. Biometrics. 1995;51(2):524–32.CrossRef
23.
go back to reference van Kempen BJ, Ferket BS, Kavousi M, Leening MJ, Steyerberg EW, Ikram MA, Witteman JC, Hofman A, Franco OH, Hunink MG. Performance of Framingham cardiovascular disease (CVD) predictions in the Rotterdam Study taking into account competing risks and disentangling CVD into coronary heart disease (CHD) and stroke. Int J Cardiol. 2014;171(3):413–8.CrossRef van Kempen BJ, Ferket BS, Kavousi M, Leening MJ, Steyerberg EW, Ikram MA, Witteman JC, Hofman A, Franco OH, Hunink MG. Performance of Framingham cardiovascular disease (CVD) predictions in the Rotterdam Study taking into account competing risks and disentangling CVD into coronary heart disease (CHD) and stroke. Int J Cardiol. 2014;171(3):413–8.CrossRef
24.
go back to reference Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, Wood AM, Lewington S, Sattar N, Packard CJ, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302(18):1993–2000.CrossRef Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, Wood AM, Lewington S, Sattar N, Packard CJ, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009;302(18):1993–2000.CrossRef
25.
go back to reference Cole JW. Large artery atherosclerotic occlusive disease. Continuum (Minneapolis, Minn). 2017;23(1, Cerebrovascular Disease):133–57. Cole JW. Large artery atherosclerotic occlusive disease. Continuum (Minneapolis, Minn). 2017;23(1, Cerebrovascular Disease):133–57.
26.
go back to reference Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;22(3):312–8.CrossRef Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;22(3):312–8.CrossRef
27.
go back to reference Zia E, Hedblad B, Pessah-Rasmussen H, Berglund G, Janzon L, Engstrom G. Blood pressure in relation to the incidence of cerebral infarction and intracerebral hemorrhage. Hypertensive hemorrhage: debated nomenclature is still relevant. Stroke. 2007;38(10):2681–5.CrossRef Zia E, Hedblad B, Pessah-Rasmussen H, Berglund G, Janzon L, Engstrom G. Blood pressure in relation to the incidence of cerebral infarction and intracerebral hemorrhage. Hypertensive hemorrhage: debated nomenclature is still relevant. Stroke. 2007;38(10):2681–5.CrossRef
28.
go back to reference Rana JS, Boekholdt SM, Ridker PM, Jukema JW, Luben R, Bingham SA, Day NE, Wareham NJ, Kastelein JJ, Khaw KT. Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC-Norfolk Prospective Population Study. J Intern Med. 2007;262(6):678–89.CrossRef Rana JS, Boekholdt SM, Ridker PM, Jukema JW, Luben R, Bingham SA, Day NE, Wareham NJ, Kastelein JJ, Khaw KT. Differential leucocyte count and the risk of future coronary artery disease in healthy men and women: the EPIC-Norfolk Prospective Population Study. J Intern Med. 2007;262(6):678–89.CrossRef
29.
go back to reference Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638–43.CrossRef Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, Renlund DG, Muhlestein JB. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638–43.CrossRef
30.
go back to reference Chaudhuri JR, Mridula KR, Umamahesh M, Swathi A, Balaraju B, Bandaru VC. High sensitivity C-reactive protein levels in Acute Ischemic Stroke and subtypes: a study from a tertiary care center. Iran J Neurol. 2013;12(3):92–7.PubMedPubMedCentral Chaudhuri JR, Mridula KR, Umamahesh M, Swathi A, Balaraju B, Bandaru VC. High sensitivity C-reactive protein levels in Acute Ischemic Stroke and subtypes: a study from a tertiary care center. Iran J Neurol. 2013;12(3):92–7.PubMedPubMedCentral
31.
go back to reference Ruparelia N, Chai JT, Fisher EA, Choudhury RP. Inflammatory processes in cardiovascular disease: a route to targeted therapies. Nat Rev Cardiol. 2017;14(3):133–44.CrossRef Ruparelia N, Chai JT, Fisher EA, Choudhury RP. Inflammatory processes in cardiovascular disease: a route to targeted therapies. Nat Rev Cardiol. 2017;14(3):133–44.CrossRef
32.
go back to reference Leening MJG, Cook NR, Franco OH, Manson JE, Lakshminarayan K, LaMonte MJ, Leira EC, Robinson JG, Ridker PM, Paynter NP. Comparison of cardiovascular risk factors for coronary heart disease and stroke type in women. J Am Heart Assoc. 2018;7(19):e007514.CrossRef Leening MJG, Cook NR, Franco OH, Manson JE, Lakshminarayan K, LaMonte MJ, Leira EC, Robinson JG, Ridker PM, Paynter NP. Comparison of cardiovascular risk factors for coronary heart disease and stroke type in women. J Am Heart Assoc. 2018;7(19):e007514.CrossRef
33.
go back to reference Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36(12):2748–55.CrossRef Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36(12):2748–55.CrossRef
34.
go back to reference Touze E, Varenne O, Calvet D, Mas JL. Coronary risk stratification in patients with ischemic stroke or transient ischemic stroke attack. Int J Stroke. 2007;2(3):177–83.CrossRef Touze E, Varenne O, Calvet D, Mas JL. Coronary risk stratification in patients with ischemic stroke or transient ischemic stroke attack. Int J Stroke. 2007;2(3):177–83.CrossRef
35.
go back to reference Witt BJ, Brown RD Jr, Jacobsen SJ, Weston SA, Yawn BP, Roger VL. A community-based study of stroke incidence after myocardial infarction. Ann Intern Med. 2005;143(11):785–92.CrossRef Witt BJ, Brown RD Jr, Jacobsen SJ, Weston SA, Yawn BP, Roger VL. A community-based study of stroke incidence after myocardial infarction. Ann Intern Med. 2005;143(11):785–92.CrossRef
36.
go back to reference Jackson CA, Hutchison A, Dennis MS, Wardlaw JM, Lindgren A, Norrving B, Anderson CS, Hankey GJ, Jamrozik K, Appelros P, et al. Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke. 2010;41(4):624–9.CrossRef Jackson CA, Hutchison A, Dennis MS, Wardlaw JM, Lindgren A, Norrving B, Anderson CS, Hankey GJ, Jamrozik K, Appelros P, et al. Differing risk factor profiles of ischemic stroke subtypes: evidence for a distinct lacunar arteriopathy? Stroke. 2010;41(4):624–9.CrossRef
37.
go back to reference Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke. 1999;30(12):2535–40.CrossRef Leppala JM, Virtamo J, Fogelholm R, Albanes D, Heinonen OP. Different risk factors for different stroke subtypes: association of blood pressure, cholesterol, and antioxidants. Stroke. 1999;30(12):2535–40.CrossRef
38.
go back to reference Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316(7139):1236–8.CrossRef Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316(7139):1236–8.CrossRef
39.
go back to reference Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6.CrossRef Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology. 1990;1(1):43–6.CrossRef
Metadata
Title
Comparison of risk factors for ischemic stroke and coronary events in a population-based cohort
Authors
Iram Faqir Muhammad
Yan Borné
Suneela Zaigham
Martin Söderholm
Linda Johnson
Margaretha Persson
Olle Melander
Gunnar Engström
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Stroke
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02344-4

Other articles of this Issue 1/2021

BMC Cardiovascular Disorders 1/2021 Go to the issue