Impact of preventable risk factors on stroke in the EPICOR study: does gender matter?

• DOI: 10.1007/s00038-017-0993-2
• Publication Date: 2017-06-22T07:56:38Z
• Authors: Slavica Trajkova; Angelo d’Errico; Fulvio Ricceri; Francesca Fasanelli; Valeria Pala; Claudia Agnoli; Rosario Tumino; Graziella Frasca; Giovanna Masala; Calogero Saieva; Paolo Chiodini; Amalia Mattiello; Carlotta Sacerdote; Salvatore Panico
• Keywords: Adult; Male; Health (social science); Cohort study; Gender medicine; Population-attributable fraction; Preventive fraction; Risk factors; Stroke; Health (social science); Public Health, Environmental and Occupational Health; Environmental and Occupational Health; Middle Aged; 3. Good health; Cohort Studies; Stroke; 03 medical and health sciences; 0302 clinical medicine; Risk factors; Italy; Risk Factors; Preventive fraction; Humans; Gender medicine; Population-attributable fraction; Female; Public Health; Sex Distribution; Cohort study; Aged

The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort.43,976 participants, age 34-75, and free of cardiovascular disease at baseline (1993-1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models.We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4-28%) for smoking and 14% (95% CI 5-22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9-26%) followed by smoking 15% (95% CI 7-22%). Their combination was 46% (95% CI 32-58%) in males and 48% (95% CI 35-59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15-27%) females 9% (95% CI 1-17%)].Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.