American Journal of Epidemiology Advance Access published online on March 22, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj110
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1 National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
* To whom correspondence should be addressed. Recently, the focus of research on cardiovascular risk factors has broadened because of new data demonstrating benefits of low risk (i.e., favorable) levels of all major modifiable risk factors. Most data on low risk relate to coronary heart disease, not stroke. This population-based, 12-sample, Italian study (Progetto CUORE, 1983-2002), with 10-year follow-up, assessed the relation of low risk to stroke and implications for prevention. At baseline, women and men were 35-69 years of age. Only 3% were low risk; 80% were high risk. Overall, stroke incidence rates were 20.7 for men and 9.6 for women per 10,000 person-years. No strokes occurred in low risk participants, and stroke incidence was low with borderline elevation of only one risk factor. Four modifiable risk factors--elevated blood pressure, smoking, diabetes, and high total cholesterol/high density lipoprotein cholesterol ratio--related independently to stroke risk. For those at low risk or who had only one unfavorable (but not high) risk factor, the stroke rate was 76% lower than for high risk participants; for all persons not at high risk, the stroke rate was 57% lower than for those at high risk. Results show that favorable risk factor levels assure minimal stroke risk. Population-wide prevention is needed, especially improved lifestyles, to increase the prevalence of low risk.
Received July 26, 2005
Accepted December 21, 2005
ORIGINAL CONTRIBUTIONS
Favorable Cardiovascular Risk Profile (Low Risk) and 10-Year Stroke Incidence in Women and Men: Findings from 12 Italian Population Samples
Simona Giampaoli 1,
Luigi Palmieri 1,
Salvatore Panico 2,
Diego Vanuzzo 3,
Marco Ferrario 4,
Paolo Chiodini 4,
Lorenza Pilotto 3,
Chiara Donfrancesco 1,
Giancarlo Cesana 5,
Roberto Sega 5,
and
Jeremiah Stamler 6 *
2 University of Naples "Federico II," Naples, Italy
3 Cardiovascular Prevention Unit, A.S.S. 4 "Medio Friuli," Udine, Italy
4 Department of Clinical and Biological Science, University of Insubria, Varese, Italy
5 Center of Chronic-Degenerative Disease, University of Milan-Biccocca, Monza, Italy
6 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
Jeremiah Stamler, E-mail: j-stamler{at}northwestern.edu
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