RESUMEN
PURPOSE: Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD. METHODS: In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers. RESULTS: Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD. CONCLUSIONS: We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.
Asunto(s)
Población Negra/estadística & datos numéricos , Enfermedad Coronaria/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Accidente Cerebrovascular/epidemiología , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/etiología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: The purpose of this case-cohort study was to examine urinary arsenic levels in relation to incident ischemic stroke in the United States. METHODS: We performed a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort. A subcohort (n=2486) of controls was randomly sampled within region-race-sex strata while all incident ischemic stroke cases from the full REGARDS cohort (n=671) were included. Baseline urinary arsenic was measured by inductively coupled plasma-mass spectrometry. Arsenic species, including urinary inorganic arsenic and its metabolites monomethylarsonic acid and dimethylarsinic acid, were measured in a random subset (n=199). Weighted Cox's proportional hazards models were used to calculate hazard ratios and 95% confidence intervals of ischemic stroke by arsenic and its species. RESULTS: The average follow-up was 6.7 years. Although incident ischemic stroke showed no association with total arsenic or total inorganic arsenic, for each unit higher level of urinary monomethylarsonic acid on a log-scale, after adjustment for potential confounders, ischemic stroke risk increased ≈2-fold (hazard ratio=1.98; 95% confidence interval: 1.12-3.50). Effect modification by age, race, sex, or geographic region was not evident. CONCLUSIONS: A metabolite of arsenic was positively associated with incident ischemic stroke in this case-cohort study of the US general population, a low-to-moderate exposure area. Overall, these findings suggest a potential role for arsenic methylation in the pathogenesis of stroke, having important implications for future cerebrovascular research.
Asunto(s)
Arsénico/toxicidad , Arsenicales/orina , Isquemia Encefálica , Accidente Cerebrovascular , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/inducido químicamente , Isquemia Encefálica/epidemiología , Isquemia Encefálica/orina , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/inducido químicamente , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/orina , Estados Unidos/epidemiologíaRESUMEN
This study examined the baseline characteristics, racial/ethnic differences, and geographic differences among participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. The SPS3 trial enrolled patients who experienced a symptomatic small subcortical stroke (lacunar stroke) within the previous 6 months and an eligible lesion on detected on magnetic resonance imaging. The patients were randomized, in a factorial design, to antiplatelet therapy (aspirin 325 mg daily plus clopidogrel 75 mg daily vs aspirin 325 mg daily plus placebo) and to one of two levels of systolic blood pressure targets ("intensive" [<130 mmHg] or "usual" [130-149 mmHg]). A total of 3020 participants were recruited from 81 clinical sites in 8 countries. In this cohort, the mean age was 63 years, 63% were men, 75% had a history of hypertension, and 37% had diabetes. The racial distribution was 51% white, 30% Hispanic, and 16% black. Compared with white subjects, black subjects were younger (mean age, 58 years vs 64 years; P <.001) and had a higher prevalence of hypertension (87% vs 70%; P <.001). The prevalence of diabetes was higher in the Hispanic and black subjects compared with the white subjects (42% and 40% vs 32%; both P <.001). Tobacco smoking at the time of qualifying stroke was much more frequent in the Spanish participants than in subjects from North America and from Latin America (32%, 22%, and 9%, respectively; P <.001). Mean systolic blood pressure at study entry was 4 mmHg lower in the Spanish subjects compared with the North American subjects (P <.01). The SPS3 cohort is the largest magnetic resonance imaging-defined series of patients with S3. Among the racially/ethnically diverse SPS3 participants, important differences in patient features and vascular risk factors could influence prognosis for recurrent stroke and response to interventions.
Asunto(s)
Antihipertensivos/administración & dosificación , Etnicidad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Grupos Raciales , Prevención Secundaria/métodos , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/prevención & control , Negro o Afroamericano , Anciano , Aspirina/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Distribución de Chi-Cuadrado , Clopidogrel , Diabetes Mellitus/etnología , Esquema de Medicación , Quimioterapia Combinada , Femenino , Hispánicos o Latinos , Humanos , Hipertensión/etnología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Prevalencia , Factores de Riesgo , Fumar/efectos adversos , Fumar/etnología , América del Sur/epidemiología , España/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivados , Factores de Tiempo , Resultado del Tratamiento , Población BlancaRESUMEN
OBJECTIVE: To determine the role of health care coverage (HCC) in follow-up of cervical cancer screening (seeking Papanicolaou test results and follow-up when abnormal results were found) among Colombian women. METHODS: A population-based cross-sectional study of 24,717 women, using the 2005 Colombian Demographic and Health Survey, was conducted. RESULTS: Nearly 4% of women screened did not seek their results. For approximately 17% of the women, there was no follow-up when abnormal results were found. Women in the contributory regime (private insurance) and those in the subsidized regime (public insurance) were more likely to seek Papanicolaou test results than women without HCC, even after adjusting for sociodemographic factors (adjusted odds ratio [ORa], 1.96; 95% confidence interval [CI], 1.60-2.41 and ORa, 1.34; 95% CI, 1.14-1.58, respectively). For follow-up when abnormal results were found, there was no difference between the subsidized regime and no HCC, but women in the contributory regime were more likely to follow-up than women without HCC (ORa, 1.40; 95% CI, 1.05-1.86). CONCLUSIONS: Seeking Papanicolaou test results is relatively high among Colombian women; however, there are differences according to HCC. Follow-up when abnormal Papanicolaou test results were found was positively associated only with private insurance; follow-up is the same for women without insurance and with public insurance. Exploring strategies to promote follow-up among women and to improve cervical cancer follow-up services for those enrolled in the subsidized regime may increase follow-up rates among Colombian women.