title: Unrecognized myocardial infarction and the risk of stroke: the Rotterdam Study.
abstract: OBJECTIVE
  To investigate the relationship between unrecognized myocardial infarction and the risk of stroke in a population-based cohort study.
  
  
  METHODS
  We followed 6,439 participants from the Rotterdam Study for stroke until January 2002. Participants were free from stroke, and presence of myocardial infarction was assessed at baseline (1990-1993). We calculated hazard ratios of stroke for persons with unrecognized or recognized myocardial infarction compared with persons without myocardial infarction. Analyses were adjusted for age, sex, and cardiovascular risk factors.
  
  
  RESULTS
  In 52,915 person-years of follow-up, 505 strokes occurred. Recognized myocardial infarction was only borderline associated with an increased risk of stroke. Unrecognized myocardial infarction increased the risk of stroke by 76% (age- and sex-adjusted hazard ratio 1.76, 95% CI 1.31 to 2.37). Stratification by sex showed that the increased risk was only found in men (hazard ratio for men 2.53, 95% CI 1.68 to 3.81; hazard ratio for women 1.27, 95% CI 0.82 to 1.96). After adjusting for cardiovascular risk factors at baseline, the risk remained significantly increased in men (hazard ratio for stroke 2.13, 95% CI 1.35 to 3.36). Subtyping of strokes revealed that unrecognized myocardial infarction was particularly associated with cortical ischemic strokes (hazard ratio for men 3.57, 95% CI 1.79 to 7.12).
  
  
  CONCLUSIONS
  Men with unrecognized myocardial infarction have an increased risk of stroke.
authors.affiliation: Department of Epidemiology and Biostatistics, Erasmus Medical Center, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Ikram
authors.forename: M
authors.initials: M
authors.lastname: Hollander
authors.forename: M J
authors.initials: MJ
authors.lastname: Bos
authors.forename: J A
authors.initials: JA
authors.lastname: Kors
authors.forename: P J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: A
authors.initials: A
authors.lastname: Hofman
authors.forename: J C M
authors.initials: JC
authors.lastname: Witteman
authors.forename: M M B
authors.initials: MM
authors.lastname: Breteler
mesh_terms: D017677:Age Distribution; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends