Page 138

Karger_ESC London_2013

22. European Stroke Conference Table 1. Vasomotor reactivity and the risk of mortality. All-cause mortality Cardiovascular mortality n/N Model I Model II n/N Model I Model II Vasomotor reactivity* Quartile 1 182/423 1.38 (1.08; 1.77) 1.33 (1.04; 1.71) 58/423 1.68 (1.06; 2.68) 1.54 (0.97; 2.47) Quartile 2 154/424 1.35 (1.05; 1.74) 1.34 (1.04; 1.72) 59/424 2.00 (1.26; 3.16) 1.99 (1.26; 3.15) Quartile 3 117/424 1.02 (0.78; 1.33) 1.03 (0.79; 1.35) 40/424 1.33 (0.81; 2.17) 1.38 (0.85; 2.26) Quartile 4 104/424 1 (refer-ence) 1 (ref-erence) 27/424 1 (refer-ence) 1 (ref-erence) Per SD 557/1695 0.90 (0.83; 0.97) 0.90 (0.83; 0.98) 184/1695 0.85 (0.75; 0.98) 0.87 (0.76; 1.00) Abbreviation: HDL = high-density lipoprotein Values are hazard ratios with 95% confidence intervals. n: number of cases N: number of persons at risk Model I: Adjusted for age and sex. Model II: Adjusted for age, sex, current smoking, former smoking, blood pressure lowering medication, systolic blood pressure, diastolic blood pressure, diabetes mellitus, total cholester-ol, and HDL-cholesterol. * Vasomotor reactivity was natural log transformed 14:30-16:00 Oral Session Room 2,3,4 Epidemiology of stroke Chairs: E. Touze, France and A. Tsiskaridze, Georgia 1 Epidemiology of stroke 14:30 - 14:40 Vasomotor reactivity and the risk of mortality: The Rotterdam Study M.L.P. Portegies1, R.F.A.G. de Bruijn2, A. Hofman3, P.J. Koudstaal4, M.A. Ikram5 Erasmus MC University Medical Center, Department of Epidemiology and Department of Neurology, Rotterdam, THE NETHERLANDS1,Erasmus MC University Medical Cen-ter, Department of Epidemiology and Department of Neurology, Rotterdam, THE NETHER-LANDS2, Erasmus MC University Medical Center, Department of Epidemiology, Rotterdam, THE NETHERLANDS3, Erasmus MC University Medical Center, Department of Neurology, Rotterdam, THE NETHERLANDS4, Erasmus MC University Medical Center, Department of Epidemiology, Department of Neurology and Department of Radiology, Rotterdam, THE NETHERLANDS5 Background: Cardiovascular and cerebrovascular diseases are the main cause of death world-wide. Though these diseases are sudden events, the underlying pathology has usually accumu-lated over the course of years. In the brain, accumulating vascular pathology can lead to loss of cerebral autoregulation, which can be measured as vasomotor reactivity (VMR). Indeed, diminished VMR has been linked with stroke. However, it remains unknown to what extent di-minished VMR also reflects systemic vascular damage. We investigated in a population-based study the association of VMR with all-cause and cardiovascular mortality, and specifically sought to study whether this association is affected by clinical stroke. Methods: Between 1997-1999, 1695 participants from the Rotterdam Study underwent VMR measurements using transcranial Doppler. These persons were followed up until 2011 for stroke and mortality. We assessed the associations between VMR and mortality using Cox proportion-al hazard models, adjusted for age and sex, and subsequently for cardiovascular risk factors. We additionally censored for incident stroke. Results: After a mean follow-up of 10.0 years, a total of 557 participants had died, of whom 184 due to a cardiovascular cause. A total of 142 persons suffered a stroke. The hazard ratio comparing the lowest to the highest quartile of VMR was 1.38 (95%-CI 1.08; 1.77) for all cause mortality and 1.68 (95%-CI 1.06; 2.68) for cardiovascular mortality, and remained un-changed after adjusting for cardiovascular risk factors. After censoring for incident stroke the hazard ratios were 1.50 (95%-CI 1.11; 2.05) for all cause mortality and 1.95 (95%-CI 1.01; 3.75) for cardiovascular mortality. Conclusion: A low VMR is associated with an increased risk of death, especially due to a car-diovascular cause. Additionally, incident stroke does not seem to affect this association, sug-gesting that a low VMR reflects an impaired vascular system not only in the brain, but more systemically. 138 © 2013 S. Karger AG, Basel Scientific Programme


Karger_ESC London_2013
To see the actual publication please follow the link above