Chagas disease predicts 10-year stroke mortality in community-dwelling elderly: the Bambui cohort study of aging.
OBJECTIVE
Previous case-control studies have suggested a causal link between Chagas disease, which is caused by the protozoan Trypanosoma cruzi, and stroke. We investigated the relationship between Chagas disease and long-term stroke mortality in a large community-based cohort of older adults.


METHODS
Participants were 1398 (80.3% from total) residents aged ≥ 60 years in Bambuí City, Brazil. The end point was death from stroke. Potential confounding variables included age, sex, conventional stroke risk factors, and high sensitive C-reactive protein.


RESULTS
Participants of this study were followed from 1997 to 2007 leading to 9740 person-years of observation. The baseline prevalence of T. cruzi infection was 37.5% and the overall mortality rate from stroke was 4.62 per 1000 person-years. The risk of death from stroke among T. cruzi-infected participants was twice that of those noninfected (adjusted hazard ratio, 2.36; 95% CI, 1.25 to 4.44). A B-type natriuretic peptide level in the top quartile was a strong and independent predictor of stroke mortality among those infected (adjusted hazard ratio, 2.72; 95% CI, 1.25 to 5.91). The presence of both a high B-type natriuretic peptide level and electrocardiographic atrial fibrillation increased the risk of stroke mortality by 11.49 (95% CI, 3.19 to 41.38) in these individuals.


CONCLUSIONS
This study provides new evidence supporting a causal link between Chagas disease and stroke. The results also showed that B-type natriuretic peptide alone or in association with atrial fibrillation has prognostic value for stroke mortality in T. cruzi chronically infected older adults.
Lima-Costa
Maria Fernanda
MF
Centro de Pesquisas Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brasil. lima-costa@cpqrr.fiocruz.br
Matos
Divane L
DL
Ribeiro
Antônio Luiz P
AL
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology* / Q000401:mortality*; D015996:Survival Rate; D014349:Trypanosoma cruzi
D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein