Impact of preventable risk factors on stroke in the EPICOR study: does gender matter?

Slavica Trajkova, Angelo d’Errico, Fulvio Ricceri, Francesca Fasanelli, Valeria Pala, Claudia Agnoli, Rosario Tumino, Graziella Frasca, Giovanna Masala, Calogero Saieva, Paolo Chiodini, Amalia Mattiello, Carlotta Sacerdote () and Salvatore Panico
Additional contact information
Slavica Trajkova: University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO)
Angelo d’Errico: Regional Health Service
Fulvio Ricceri: University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO)
Francesca Fasanelli: University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO)
Valeria Pala: Fondazione IRCCS Istituto Nazionale dei Tumori
Claudia Agnoli: Fondazione IRCCS Istituto Nazionale dei Tumori
Rosario Tumino: Cancer Registry, Department of Prevention
Graziella Frasca: Cancer Registry, Department of Prevention
Giovanna Masala: Cancer Risk Factors and Lifestyle Epidemiology Unit Cancer Research and Prevention Institute-ISPO
Calogero Saieva: Cancer Risk Factors and Lifestyle Epidemiology Unit Cancer Research and Prevention Institute-ISPO
Paolo Chiodini: Second University of Naples
Amalia Mattiello: Federico II University
Carlotta Sacerdote: University of Turin and Città della Salute e della Scienza University-Hospital Center for Cancer Prevention (CPO)
Salvatore Panico: Federico II University

International Journal of Public Health, 2017, vol. 62, issue 7, No 9, 775-786

Abstract: Abstract Objectives The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort. Methods 43,976 participants, age 34–75, and free of cardiovascular disease at baseline (1993–1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models. Results We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4–28%) for smoking and 14% (95% CI 5–22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9–26%) followed by smoking 15% (95% CI 7–22%). Their combination was 46% (95% CI 32–58%) in males and 48% (95% CI 35–59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15–27%) females 9% (95% CI 1–17%)]. Conclusions Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.

Keywords: Stroke; Gender medicine; Risk factors; Cohort study; Population-attributable fraction; Preventive fraction (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s00038-017-0993-2

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