Relative risks for stroke by age, sex, and population based on follow-up of 18 European populations in the MORGAM Project.
OBJECTIVE
Within the framework of the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project, the variations in impact of classical risk factors of stroke by population, sex, and age were analyzed.


METHODS
Follow-up data were collected in 43 cohorts in 18 populations in 8 European countries surveyed for cardiovascular risk factors. In 93 695 persons aged 19 to 77 years and free of major cardiovascular disease at baseline, total observation years were 1 234 252 and the number of stroke events analyzed was 3142. Hazard ratios were calculated by Cox regression analyses.


RESULTS
Each year of age increased the risk of stroke (fatal and nonfatal together) by 9% (95% CI, 9% to 10%) in men and by 10% (9% to 10%) in women. A 10-mm Hg increase in systolic blood pressure involved a similar increase in risk in men (28%; 24% to 32%) and women (25%; 20% to 29%). Smoking conferred a similar excess risk in women (104%; 78% to 133%) and in men (82%; 66% to 100%). The effect of increasing body mass index was very modest. Higher high-density lipoprotein cholesterol levels decreased the risk of stroke more in women (hazard ratio per mmol/L 0.58; 0.49 to 0.68) than in men (0.80; 0.69 to 0.92). The impact of the individual risk factors differed somewhat between countries/regions with high blood pressure being particularly important in central Europe (Poland and Lithuania).


CONCLUSIONS
Age, sex, and region-specific estimates of relative risks for stroke conferred by classical risk factors in various regions of Europe are provided. From a public health perspective, an important lesson is that smoking confers a high risk for stroke across Europe.
Asplund
Kjell
K
Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden. Kjell.Asplund@branneriet.se
Karvanen
Juha
J
Giampaoli
Simona
S
Jousilahti
Pekka
P
Niemelä
Matti
M
Broda
Grazyna
G
Cesana
Giancarlo
G
Dallongeville
Jean
J
Ducimetriere
Pierre
P
Evans
Alun
A
Ferrières
Jean
J
Haas
Bernadette
B
Jorgensen
Torben
T
Tamosiunas
Abdonas
A
Vanuzzo
Diego
D
Wiklund
Per-Gunnar
PG
Yarnell
John
J
Kuulasmaa
Kari
K
Kulathinal
Sangita
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011153:Population; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology*; D014944:World Health Organization