title: Vital exhaustion increases the risk of ischemic stroke in women but not in men: results from the Copenhagen City Heart Study.
abstract: BACKGROUND
  Several studies have indicated an association between depression and the development of stroke, but few studies have focused on gender differences, although both depression and stroke are more common in women than in men. The aim of the present study was to describe whether vital exhaustion, a measure of fatigue and depression, prospectively predicts ischemic and hemorrhagic strokes in a large cohort, with particular focus on gender differences.
  
  
  METHODS
  The cohort was composed of 5219 women and 3967 men without cardiovascular disease who were examined in the Copenhagen City Heart Study in 1991-1994. Subjects were followed for 6-9 years. Fatal and nonfatal strokes were ascertained from the Danish National Register of Patients. Cox proportional hazards model was used to describe vital exhaustion as a potential risk factor for stroke.
  
  
  RESULTS
  Four hundred nine validated strokes occurred. A dose-response relationship between vital exhaustion score and the risk of stroke was found in women reaching a hazard ratio (HR) of 2.27 (95% confidence interval: 1.42-3.62) for the group with the highest score. HR was only slightly attenuated by multivariate adjustment. There was no association between vital exhaustion score and stroke in men. HR was strongest for ischemic stroke, whereas no association was seen for hemorrhagic stroke.
  
  
  CONCLUSIONS
  Vital exhaustion, a measure of fatigue, conveyed an increased risk of ischemic stroke in women, but not in men, in this study sample.
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark. henriettepetersen@dadlnet.dk
authors.forename: Henriette
authors.initials: H
authors.lastname: Kornerup
authors.forename: Jacob Louis
authors.initials: JL
authors.lastname: Marott
authors.forename: Peter
authors.initials: P
authors.lastname: Schnohr
authors.forename: Gudrun
authors.initials: G
authors.lastname: Boysen
authors.forename: John
authors.initials: J
authors.lastname: Barefoot
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications*; D005221:Fatigue / Q000150:complications*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000209:etiology*