From the Department of Clinical Biochemistry (J.R., S.A., B.G.N.) and Copenhagen General Population Study (J.R., B.G.N., S.A.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev; Copenhagen City Heart Study (B.G.N., G.B.J.), Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg; and Faculty of Health and Medical Sciences (J.R., B.G.N.), University of Copenhagen, Denmark.
Neurology. 2019 Oct 1;93(14):e1397-e1407. doi: 10.1212/WNL.0000000000008193. Epub 2019 Aug 30.
To test the hypothesis that the associations of body mass index (BMI) and BMI-related risk factors with risk of stroke have attenuated over time using cohorts recruited from the general population over 4 decades.
We undertook prospective studies of 2 cohorts enrolled in 1976 to 1978 (13,567 participants from the Copenhagen City Heart Study) and 2003 to 2015 (107,040 participants from the Copenhagen General Population Study). Each cohort was recruited randomly from the Danish general population 20 to 100 years of age. Participants were followed up from the date of examination to date of emigration, death, or stroke event, whichever occurred first. Follow-up ended in March 2017. We did not lose track of any individual. BMI and blood pressure were modeled with splines and in categories. Main outcome was incident stroke, including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.
The crude incidence of stroke declined in extreme categories of BMI and blood pressure from 1977 to 2017. The multivariable-adjusted hazard ratios for stroke in participants with BMI ≥30 vs 18.5 to 24.9 kg/m were 1.4 (95% confidence interval 1.2-1.6) in the 1976-1978 cohort and 1.1 (1.0-1.2) in the 2003-2015 cohort ( = 0.008 for 1976-1978 vs 2003-2015). The corresponding hazard ratios (confidence intervals) in participants with blood pressure ≥160/100 vs <140/90 mm Hg were 2.1 (1.9-2.3) and 1.5 (1.4-1.7), respectively ( < 0.001). Similar secular trends were observed for diabetes mellitus but were not obvious for other risk factors.
The associations of high BMI and high blood pressure with higher risk of stroke were attenuated across 2 Danish cohorts enrolled from 1976 through 2015.
利用 40 多年来从普通人群中招募的队列，检验体重指数（BMI）和 BMI 相关危险因素与中风风险的关联随时间推移而减弱的假设。
我们进行了两项前瞻性研究，纳入了 1976 年至 1978 年（来自哥本哈根城市心脏研究的 13567 名参与者）和 2003 年至 2015 年（来自哥本哈根普通人群研究的 107040 名参与者）的两个队列。每个队列都是从丹麦普通人群中随机招募的，年龄在 20 至 100 岁之间。参与者从体检之日起至移民、死亡或中风事件发生之日（以先发生者为准）进行随访。随访于 2017 年 3 月结束。我们没有漏掉任何一个人。BMI 和血压采用样条和分类进行建模。主要结局是中风事件，包括缺血性中风、脑出血和蛛网膜下腔出血。
1977 年至 2017 年，BMI 和血压极端类别中风的粗发病率下降。与 BMI18.5-24.9kg/m 相比，BMI≥30kg/m 的参与者中风的多变量调整后的风险比为 1.4（95%置信区间 1.2-1.6）在 1976-1978 队列中，2003-2015 队列中为 1.1（1.0-1.2）（1976-1978 与 2003-2015 相比，=0.008）。血压≥160/100mmHg 与<140/90mmHg 的参与者相应的风险比（置信区间）分别为 2.1（1.9-2.3）和 1.5（1.4-1.7）（<0.001）。类似的趋势在糖尿病中也有观察到，但在其他危险因素中并不明显。
在 1976 年至 2015 年期间从丹麦两个队列中招募的参与者中，高 BMI 和高血压与更高的中风风险之间的关联随时间推移而减弱。
