Risk factors for death from stroke in middle-aged Lithuanian men - Results from a 20-year prospective study

Background and Purpose Although in Eastern Europe, mortality from stroke at present is the highest in the world, no previous prospective study of the risk factors for stroke has been reported from this part of the world. The aim of our study, therefore, was to evaluate the relations between blood pressure, serum total cholesterol, glucose intolerance, body mass index, and cigarette smoking and the risk of death from stroke in middle-aged men in Kaunas, Lithuania. Methods We conducted a prospective study with an average follow-up of 17.5 years of 2295 men who had participated in risk factor surveys within the framework of the World Wealth Organization Kaunas-Rotterdam Intervention Study from 1972 to 1974. Risk factors included in the current analyses were smoking, blood pressure, serum total cholesterol, glucose intolerance, diabetes, and body mass index. Age- and risk factor-adjusted relative risks (RR) for death of stroke were determined by use of the Cox proportional hazards model. Results The strongest risk factors for death from stroke in middle-aged men were systolic blood pressure (RR=1.02; P=.0001), diabetes (RR=4.17; P=.02), and smoking (RR=2.01; P=.004). Serum cholesterol, impaired glucose tolerance, and body mass index were not related to the risk of death from stroke. Twenty-five percent and 19% of stroke deaths were attributed to hypertension and smoking, respectively. Conclusions Prevention and effective control of hypertension, smoking, and diabetes are the key elements in primary prevention of stroke in eastern Europe, where stroke mortality remains high.