Department of Neurology, Seoul Medical Center, Seoul, Korea.
Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
J Stroke. 2015 Sep;17(3):302-11. doi: 10.5853/jos.2015.17.3.302. Epub 2015 Sep 30.
Estimating age- and sex-specific population attributable risks (PARs) of major risk factors for stroke may be a useful strategy to identify risk factors for targeting preventive strategies.
For this case-control matched study, consecutive patients aged 18-90 years and admitted to nine nationwide hospitals with acute ischemic stroke between December 2008 and June 2010, were enrolled as cases. Controls, individually matched by age and sex, were chosen from the 4th Korean National Health & Nutrition Examination Survey (2008-2010). Based on odds ratios and prevalence, standardized according to the age and sex structure of the Korean population, PARs of major risk factors were estimated according to age (young, ≤ 45; middle-aged, 46-65; and elderly, ≥ 66 years) and sex subgroups.
In 4,743 matched case-control sets, smoking (PAR, 45.1%) was the greatest contributing risk factor in young men, followed by hypertension (28.5%). In middle-aged men, the greatest contributing factors were smoking (37.4%), hypertension (22.7%), and diabetes (14.6%), whereas in women the greatest factors were hypertension (22.7%) and stroke history (10.6%). In the elderly, hypertension was the leading factor in men (23.7%) and women (23.4%). Other noticeable factors were stroke history (men, 19.7%; women, 17.3%) and diabetes (men, 12.5%; women, 15.1%). In young women, risk factors with a PAR greater than 10% were not found.
Smoking cessation in young people and hypertension and diabetes control in older people may be effective in reducing the burden of stroke on the population. In the elderly, secondary prevention could also be emphasized.
估计卒中主要危险因素的年龄和性别特异性人群归因风险（PAR）可能是一种有用的策略，可用于确定针对预防策略的危险因素。
本病例对照匹配研究连续纳入 2008 年 12 月至 2010 年 6 月期间因急性缺血性卒中入住全国 9 家医院的 18-90 岁患者作为病例。通过年龄和性别与病例相匹配，从第四次韩国国家健康和营养调查（2008-2010 年）中选择对照。根据比值比和流行率，并按照韩国人口的年龄和性别结构进行标准化，根据年龄（年轻，≤45 岁；中年，46-65 岁；老年，≥66 岁）和性别亚组估计主要危险因素的 PAR。
在 4743 对匹配的病例对照中，吸烟（PAR，45.1%）是年轻男性中最大的致病危险因素，其次是高血压（28.5%）。在中年男性中，最大的致病因素是吸烟（37.4%）、高血压（22.7%）和糖尿病（14.6%），而在女性中，最大的因素是高血压（22.7%）和卒中史（10.6%）。在老年男性和女性中，高血压是主要因素（男性 23.7%，女性 23.4%）。其他值得注意的因素是卒中史（男性 19.7%，女性 17.3%）和糖尿病（男性 12.5%，女性 15.1%）。在年轻女性中，未发现 PAR 大于 10%的危险因素。
在年轻人中戒烟和在老年人中控制高血压和糖尿病可能会有效降低人群卒中负担。在老年人中，也可以强调二级预防。
