Year: 2014
Type: dissertation
Study design: Observational Study
Abstract: Stroke is a severe disease that affects 30,000 people in Sweden every year. Three quarters of stroke events are first time events. The risk of premature death and disability is high among stroke survivors. Knowledge about risk factors, trends in incidence and prognosis after stroke is important to reduce the risk and improve the outcome. The aim of this thesis was to investigate the long-term risk of coronary heart disease (CHD) and stroke among men from middle age and extending into old age, temporal trends in ischemic stroke (IS) incidence, and prognosis after stroke among younger IS patients (18-54years). For this purpose the Primary Prevention (PPS) study was used in Paper I. Data from the Swedish Inpatient Register (IPR) and Cause of Death Register was used in Paper II to IV.The European Systematic Coronary Risk Evaluation (SCORE) model estimates the 10-year risk of cardiovascular mortality among middle-aged people. This model is based on five risk factors: age, gender, blood pressure, serum cholesterol and smoking status. Paper I showed that the importance of these risk factors differed considerably when estimating the short-term (0-10 years) and long-term (0-35 years) risk of CHD and stroke, such that the prediction was better for CHD than for stroke.\nDuring 1987 to 2010 the incidence of IS decreased among elderly (65-84 years) and middle-aged (45-\n64 years) people. However, among younger people (18-44 years) the incidence increased about 1.5%\nper year during the same period of time. From 1987 to 2006 the 4-year mortality risk decreased among\nyoung men and women after an IS. Similar findings were observed for recurrent IS. In addition, we\nobserved that most of the decline in recurrence occurred within the first year. In conclusion, this thesis showed that CHD and stroke differs not only by their clinical manifestations\nbut also by how they were influenced by different risk factors at baseline over an extended follow-up.\nThe risk of IS declined for older but not among young people which is a worrying trend but prognosis\nafter stroke has improved over time among younger IS patients, however, the risk of either death or\nrecurrent IS is still high.
Author: Kok Wai Giang
Institution: University of Gothenburg
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W42092917