London, United Kingdom 2013 6 Etiology of stroke and risk factors A 15:20 - 15:30 Apathy and the risk of stroke and cardiovascular disease: a prospective population based study E. Richard1, L.S. Eurelings2, S.A. Ligthart3, J. van Dalen4, E.P. Moll van Charante5, W.A. van Gool6 Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHER-LANDS1, Academic Medical Center, University of Amsterdam, Amsterdam, THE NETH-ERLANDS2, Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS3, Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS4, Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS5, Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS6 Background: Symptoms of apathy are common in the elderly and are associated with a history of stroke, cardiovascular disease and presence of cardiovascular risk factors. The aim of this study is to assess whether symptoms of apathy or depression increase the risk of incident stroke or cardio-vascular Cerebrovasc Dis 2013; 35 (suppl 3)1-854 53 disease. Methods: Prospective population-based cohort within the ongoing ‘prevention of dementia by intensive vascular care’ study (preDIVA), including 1810 community-dwelling participants (70-78 years) without a history of cardiovascular disease or stroke. Symptoms of apathy were assessed with three items of the 15-item Geriatric Depression Scale (GDS-3A) and symptoms of depression with the remaining 12 items. The association of apathy and depression with incident stroke and cardiovascular disease was analysed using logistic regression. Results: Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants respectively. Incident stroke occurred in 55 (3.1%) and cardiovascular disease in 62 (3.5%) participants, four fatal in each group. Symptoms of apathy were associated with incident car-diovascular disease after adjustment for demographic characteristics and cardiovascular risk factors (OR 2.60, 95%CI 1.46 to 4.65). This association remained after excluding subjects with more than one depressive symptom (subjects with isolated apathy: n=1544, OR 2.94, 95%CI 1.45 to 5.96). No significant association was found between depressive symptoms and incident cardiovascular disease. Neither apathy symptoms, nor depressive symptoms were associated with incident stroke. Conclusion: Symptoms of apathy are independently associated with an increased risk of incident cardiovas-cular disease, but not with incident stroke. Apathy could be considered an important marker of incipient cardiovascular disease. Since apathy can lead to withdrawal from medical care, recog-nition of these subjects at increased risk of cardiovascular disease in clinically relevant. Table 2 Contribution of lifestyle behaviours, physiological and psychosocial risk factors in ex-plaining the relationship between each of education and home ownership and stroke Education (comparing highest vs lowest) Home ownership (No versus yes) Model OR (95% CI) % differ-ence† OR (95% CI) % differ-ence† Base-line model* + ad-just-ment for me-diators: Life-style Smoking 2.42 (1.33 to 4.38) -6.4 1.85 (1.29 to 2.66) -10.6 Alcohol use 2.34 (1.28 to 4.26) -9.9 1.91 (1.33 to 2.74) -6.0 Body mass index 2.46 (1.35 to 4.46) -7.7 1.93 (1.35 to 2.77) -4.4 Physical activity 2.39 (1.32 to 4.33) -4.6 1.92 (1.34 to 2.74) -5.2 All lifestyle be-haviours 2.03 (1.11 to 3.73) -25.0 1.78 (1.24 to 2.56) -16.2 Phys-io-logi-cal Hypertension 2.52 (1.39 to 4.56) -2.1 1.93 (1.35 to 2.77) -4.4 Heart disease 2.49 (1.38 to 4.51) -2.9 1.89 (1.32 to 2.71) -7.5 Diabetes 2.50 (1.38 to 4.52) -3.4 1.93 (1.35 to 2.77) -4.4 Hysterectomy/ oo-phorectomy 2.29 (1.26 to 4.15) -12.2 1.93 (1.35 to 2.77) -4.4 All physiological factors 2.20 (1.21 to 4.01) -16.5 1.85 (1.29 to 2.66) -10.6 Psy-cho-social Depression 2.32 (1.28 to 4.20) -10.8 1.82 (1.27 to 2.61) -13.0 Marital status 2.62 (1.44 to 4.75) +2.0 1.85 (1.28 to 2.68) -10.6 All psychosocial factors 2.34 (1.29 to 4.26) -9.9 1.78 (1.23 to 2.57) -16.2 *Adjusted for age and home ownership or education †Percentage attenuation in log OR = 100 × (βSES+age – βSES+risk factor(s)) / (βSES), where β = log(OR); baseline OR for education: 2.57, 95% CI 1.42 to 4.65 and homeownership: 1.99, 95% CI 1.39 to 2.84
Karger_ESC London_2013
To see the actual publication please follow the link above