title: Factors associated with the steep increase in late-midlife stroke occurrence among US men.
abstract: BACKGROUND
  Data on recent stroke prevalence rates among middle-aged men in the United States indicate that men aged 55 to 64 years are 3 times more likely than men aged 45 to 54 years to have experienced a stroke. We aimed to determine potential risk factors that may contribute to this steep increase in late midlife stroke occurrence.
  
  
  METHODS
  We analyzed the National Health and Nutrition Examination Survey 1999 to 2004 data sets, assessing stroke prevalence, predictors of stroke occurrence, and vascular risk factors in men across their midlife years.
  
  
  RESULTS
  Crudely, higher glycohemoglobin, history of hypertension, history of diabetes, and history of coronary artery disease significantly predicted stroke in 45- to 54- and 54-to 64-year-old men. Significant stroke risk factors unique to each age group were non-white race, lower ankle-brachial pulsatility index, and occurrence of recent severe headache in the 45- to 54-year age group, whereas elevated serum homocysteine (HCY) level predicted stroke in those aged 55 to 64 years. In multivariable regression analysis, lower ankle-brachial pulsatility index (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.47-1.83, P < .001) and recent severe headache (OR 5.12, 95% CI 1.3-20.1, P = .019) were the only independent predictors of stroke in the 45- to 54-year age group, whereas only elevated HCY predicted stroke in the 55- to 64-year age group (OR 1.708, 95% CI -1.103-2.643, P = .0163).
  
  
  CONCLUSIONS
  Elevated serum HCY level is the sole independent predictor of stroke among men aged 55 to 64 years in the United States. Further study to assess the efficacy of HCY-lowering treatment in mitigating a steep increase in late midlife stroke occurrence among men may be warranted.
authors.affiliation: Stroke Center and Department of Neurology, University of California at Los Angeles Medical Center, Los Angeles, California, USA. towfighi@usc.edu
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Rita
authors.initials: R
authors.lastname: Engelhardt
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006261:Headache / Q000453:epidemiology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin