title: Hospitalised ischaemic cerebrovascular accident and risk factors in a primary care database.
abstract: OBJECTIVE
  Ischaemic cerebrovascular accident (ICVA) is a common cause of morbidity and mortality. Identification of risk factors can reduce its incidence. We aim to estimate the incidence rate (IR) of hospitalised ICVA in the general population by sex and quantify its risk associated with several factors.
  
  
  METHODS
  We followed up 907, 001 individuals aged 40-84 years during a mean of 3.63 years to ascertain the first episode of hospitalised ICVA between 2000 and 2004 using a UK primary care database. We evaluated the risk factors for ICVA through unconditional logistic regression (OR) with a nested case-control analysis, using 2953 incident cases and 10, 000 random controls frequency-matched by age, sex and year.
  
  
  RESULTS
  The IR of hospitalised ICVA was 1.94 (95%CI: 1.87-2.01) per 1000 person-years in men and 1.59 (95%CI: 1.53-1.65) in women. The IR ratio adjusted by age was 1.35 (95%CI: 1.28-1.43). Major risk factors for the first ICVA were atrial fibrillation (AF) (OR of 1.96 (95%CI: 1.59-2.42) for men and 3.54 (95%CI: 2.85-4.39) for women), smoking, epilepsy and hypertension. AF patients on anticoagulant therapy presented a reduced risk of ICVA (OR: 0.39; 95%CI: 0.27-0.56) in both sexes. Hypertensive women that discontinued the treatment had an increased risk (OR: 2.53; 95%CI: 1.63-3.91).
  
  
  CONCLUSIONS
  Men had higher incidence of hospitalised ICVA than women. AF was the major risk factor for ICVA (more in women than men), followed by smoking. Among AF patients, those under anticoagulant therapy showed a significant reduced risk of first ICVA. Antihypertensive drug discontinuation increased the risk of ICVA among women.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain. elisaceife@telefonica.net
authors.forename: Elisa
authors.initials: E
authors.lastname: Martín-Merino
authors.forename: Ana
authors.initials: A
authors.lastname: Ruigomez
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.forename: Luis-Alberto
authors.initials: LA
authors.lastname: García-Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents