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Lifetime predictors of stroke in subjects without a diagnosis of hypertension: the aerobics center longitudinal study

Authors Cavero-Redondo I, Sui X, Blair SN, Lavie CJ, Álvarez-Bueno C, Martínez-Vizcaíno V

Received 8 November 2018

Accepted for publication 24 January 2019

Published 8 April 2019 Volume 2019:15 Pages 849—856

DOI https://doi.org/10.2147/NDT.S193842

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder


Iván Cavero-Redondo,1 Xuemei Sui,2 Steven N Blair,2 Carl J Lavie,3 Celia Álvarez-Bueno,1 Vicente Martínez-Vizcaíno1,4

1Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; 2Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; 3Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA; 4Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile

Background and purpose: Although several studies have assessed the importance of traditional risk factors in predicting stroke, none have concurrently addressed the stroke-predicting ability of these risk factors across the lifespan of subjects without a hypertension (HTN) diagnosis. Thus, this study aimed to assess the importance of blood-pressure-related risk indicators, cardiorespiratory fitness (CRF), weight status, diabetes mellitus (DM), and lifestyle factors as predictors of stroke in different stages of life among non-hypertensive subjects.
Materials and methods: This study was a long-term follow-up study including 33,254 men and 10,598 women from the Aerobics Center Longitudinal Study (ACLS) who were 18–100 years old and did not have a HTN diagnosis at baseline. Logistic regression models were constructed using forward selection procedures for each age category, with stroke occurrence as the dependent variable, and pulse pressure (PP), mean arterial pressure (MAP), systolic blood pressure (SBP), smoking status, CRF, drinking behavior, DM status, and weight status as potential predictors.
Results: In total, 507 subjects had a stroke during an average follow-up period of 17 years (range=1–34 years). Logistic regression models showed that MAP values (P=0.043) in those aged 19–39 years; SBP (P<0.001), CRF (P=0.001), weight status (P=0.005), and alcohol consumption (P=0.001) in those 40–60 years old; and CRF (P=0.002), weight status (P=0.005), and DM status (P=0.037) in those over 60 years old were predictors of stroke.
Conclusion: These findings suggest that, among individuals without a baseline HTN diagnosis, classic modifiable risk factors for stroke change across different stages of life.

Keywords: stroke, risk factors, cohort study, incidence, cerebrovascular disease


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