Metabolic risk factors for stroke and transient ischemic attacks in middle-aged men: a community-based study with long-term follow-up.
OBJECTIVE
The impact of lipometabolic and glucometabolic disturbances on stroke incidence remains to be characterized in detail. We investigated relations of a comprehensive panel of baseline lipometabolic and glucometabolic variables to incident fatal and nonfatal stroke or transient ischemic attack (TIA), and stroke subtypes.


METHODS
A community-based prospective study of 2313 middle-aged men invited to a health survey at age 50.


RESULTS
During a follow-up of up to 32 years, 421 developed stroke or TIA. In Cox proportional hazards analyses adjusting for treatment with cardiovascular drugs at baseline, 1-standard deviation increases in body mass index, systolic and diastolic blood pressures, serum proinsulin, and lipoprotein(a) were associated with 11 to 35% increased risk for subsequent stroke/TIA. Electrocardiographic left ventricular hypertrophy and smoking were also associated with a higher risk for stroke/TIA. Essentially the same variables were related to brain infarction/TIA. Higher proportions of palmitic (16:0), palmitoleic (16:1), and oleic acid (18:1) in cholesterol esters were associated with an increased risk, whereas a higher proportion of linoleic acid (18:2 n-6) was protective against stroke/TIA. Further adjusting all models also for hypertension, diabetes, the metabolic syndrome, serum cholesterol, atrial fibrillation, cardiovascular disease, smoking, and physical activity, essentially the same pattern was observed.


CONCLUSIONS
Indices of an unhealthy dietary fat intake and a high serum lipoprotein (a) level predicted fatal and nonfatal stroke/TIA independently of established risk factors in a community-based sample of middle-aged men followed for 32 years.
Wiberg
Bernice
B
Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala Science Park, SE-751 85 Uppsala, Sweden. bernice.wiberg@akademiska.se
Sundström
Johan
J
Arnlöv
Johan
J
Terént
Andreas
A
Vessby
Bengt
B
Zethelius
Björn
B
Lind
Lars
L
D000368:Aged; D000369:Aged, 80 and over; D004041:Dietary Fats / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood* / Q000453:epidemiology*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology*; D013997:Time Factors
D004041:Dietary Fats; D008074:Lipoproteins