title: Major life events increase the risk of stroke but not of myocardial infarction: results from the Copenhagen City Heart Study.
abstract: BACKGROUND
  More attention has been paid to psychosocial conditions as possible risk factors for cardiovascular disease (CVD) and the impact of accumulated major life events (MLE) on the development of CVD has received little attention.
  
  
  METHODS
  The aim of this study was to explore the influences of MLE on CVD risk in a large cohort study.
  
  
  METHODS
  The study population consisted of 9542 randomly selected adults free of CVD examined in the Copenhagen City Heart Study in 1991-1994 and followed up for CVD defined as myocardial infarction or ischaemic stroke until 2001. MLE were analysed using an 11-item questionnaire and hazard ratios (HR) were calculated using the Cox proportional hazards model.
  
  
  RESULTS
  During follow-up there were 443 myocardial infarctions (MI) and 350 ischaemic strokes. Financial problems in both childhood and adulthood were associated with risk of stroke with an HR of 1.71 (95% CI: 1.29-2.26) and 1.60 (1.12-2.30), respectively. Accumulation of MLE was also associated with risk of stroke with HR reaching a maximum of 1.41 (95% CI: 1.06-1.90) for more than one event in childhood and 1.49 (95% CI: 1.09-2.04) for more than one event in adulthood. MLE accumulated over a life course showed a dose-response relationship with stroke. Associations were somewhat attenuated by adjustment for vital exhaustion suggesting a mediating role, but not by adjustment for behavioural risk factors. There were no associations between MLE and MI.
  
  
  CONCLUSIONS
  In this population-based cohort study, we found that MLE conveyed a moderately increased risk of stroke partly mediated through vital exhaustion. We found no association between MLE and the risk of MI.
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark. henriettepetersen@dadlnet.dk
authors.forename: Henriette
authors.initials: H
authors.lastname: Kornerup
authors.forename: Merete
authors.initials: M
authors.lastname: Osler
authors.forename: Gudrun
authors.initials: G
authors.lastname: Boysen
authors.forename: John
authors.initials: J
authors.lastname: Barefoot
authors.forename: Peter
authors.initials: P
authors.lastname: Schnohr
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark / Q000453:epidemiology; D005221:Fatigue / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors