Background
Methods
Systematic literature search
Inclusion and exclusion criteria
Selection and data extraction
Quality assessment and statistical analyses
Results
Included studies
First author | Publication year | Sex | Research site | Type of stroke | Sample (person-years) | Sample who had a stroke | Risk factors (Sample who had a stroke) | Source of the cohort |
---|---|---|---|---|---|---|---|---|
A.G. Shaper [11] | 1991 | Men | England | Ischemic & hemorrhagic | 7,735 | 110 | Smoking (98) | The British Regional Heart Study [24] |
Kathryn M. Rexrode [25] | 1997 | Women | England | Ischemic & hemorrhagic | 866 | 672 | BMI (672) | |
K. Berger [28] | 1998 | Men & women | Germany | Ischemic & hemorrhagic | 12,866 | 39 | SBP (36), Hypertension (17), Diabetes (3), Smoking (19) | |
Leon A. Simons [31] | 1998 | Men & women | Australia | Ischemic & hemorrhagic | 2,805 | 306 | BMI (306), SBP (306), Diabetes (N/A), Coronary heart disease (N/A), AF (N/A), Smoking (N/A) | The Dubbo Study [32] |
K.S. Wong [33] | 1999 | Men & women | Asian◆
| Ischemic & hemorrhagic | 3,186 | 2,403 | AF (265), Diabetes (634), Ischemic heart disease (431) | The hospital participants in an Asian country |
P McCarron [34] | 2001 | Men | England | Ischemic & hemorrhagic | 4,826 | 293 | BMI (293), SBP (293), Diabetes (13), AF (9), Smoking (87) | |
Yao He [37] | 2003 | Men & women | China | Ischemic & hemorrhagic | 1,268 | 45 | BMI (45), SBP (45), Hypertension (N/A) | The cadre's sanitarium in Xi’an, China |
Helen Rodgers [38] | 2004 | Men & women | Northern England | Ischemic & hemorrhagic | 4,440 | 329 | BMI (329), Hypertension (150), Diabetes (24), Coronary heart disease (53), AF (32), LVH (45), Alcohol (124), Smoking (84) | The population-based survey of atrial fibrillation [39] |
Yun-Mi Song (a) [40] | 2004 | Men | Korea | Ischemic & hemorrhagic | 234,863 | 7,444 | BMI (7,444), SBP (7,444) | The participants were provided by KNHS. |
Yun-Mi Song (b) [41] | 2004 | Men & women | Korea | Ischemic & hemorrhagic | 14,057 | 10,716 | SBP (10,716) | The participants were provided by KNHS. |
Xiao-Fei Zhang [42] | 2004 | Men | China | Ischemic & hemorrhagic | 5,092 | 124 | BMI (124), SBP (124), Hypertension (80), Smoking (124) | The workforce of Beijing, China |
Wei Wang [43] | 2006 | Men & women | China | Ischemic & hemorrhagic | 30,378 | 565 | SBP (565), Smoking (188), Diabetes (57) | The CMCS study
△
[44] |
Per Harmsen [45] | 2006 | Men | Sweden | Ischemic & hemorrhagic | 7,457 | 317 | BMI (317), SBP (317), Diabetes (147), AF (37), Smoking (159) | The Multifactor Primary Prevention Study [46] |
Mohsen Janghorbani [47] | 2007 | Women | Iran | Ischemic & hemorrhagic | 121,701 | 2,384 | Diabetes (92) | |
Truong-Minh Pham [48] | 2007 | Men & women | Japan | Ischemic & hemorrhagic | 9,651 | 226 | BMI (226), Hypertension (80), Smoking (108), Alcohol (61) | |
Cornelia Weikert [51] | 2007 | Men & women | Germany | Ischemic | 25,538 | 85 | Hypertension (74), Diabetes (14), Alcohol (27) | The European Prospective Investigation into Cancer and Nutrition [52] |
Yan Wang [53] | 2007 | Men & women | China | Ischemic & hemorrhagic | 56,510 | 78 | Diabetes (33), Alcohol (24), Smoking (38) | Community residents of Shanghai, China |
Michiaki Kubo [54] | 2008 | Men & women | Japan | Ischemic | 6390 | 430 | Hypertension (N/A), Diabetes (N/A), Smoking (N/A), Alcohol (N/A) | The Hisayama Study [55] |
Ying Zhang [56] | 2008 | Men & women | American | Ischemic & hemorrhagic | 4549 | 306 | SBP (306), Hypertension (170), Diabetes (211), Alcohol (153), Smoking (221) | |
George Howard [60] | 2011 | Men & women | American | Ischemic & hemorrhagic | 1842 | 427 | SBP (427), Diabetes (110), Coronary heart disease (131), AF (64), LVH (26), Smoking (89) | The REGARDS study [61]
△
|
I Saito [62] | 2011 | Men & women | Japan | Ischemic & hemorrhagic | 71762 | 2,119 | BMI (2119) | The Japan Public Health Center-based prospective (JPHC) Study |
Ulla Brasch Mogensen [63] | 2012 | Men & women | Denmark | Ischemic & hemorrhagic | 240,000 | 988 | Hypertension (304), Diabetes (145), AF (161), Smoking (362), Alcohol (260) |
Study characteristics
Synthesis of results
Risk factors | Number of references (Western) | Endpoints/Individuals (Western) | Pooled HR (Western) | Pooled 95% CI (Western) | P (Western) | Number of references (Asian) | Endpoints/Individuals (Asian) | Pooled HR (Asian) | Pooled 95% CI (Asian) | P (Asian) |
---|---|---|---|---|---|---|---|---|---|---|
BMI (kg/m
2
)
| ||||||||||
22.0-24.9 | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
18. 5–21. 9 | 3F
| 447**/1,917 | 0.96(1)
| 0.93 ~ 0.99(1)
| 0.010*
| 5R
| 1,124**/9,985 | 0.97(9)
| 0.88 ~ 1.08(9)
| 0.626 |
≥25.0 | 4R
| 389**/1,917 | 1.21(1)
| 0.99 ~ 1.48(1)
| 0.159 | 4R
| 2,233**/9,985 | 1.28(9)
| 1.15 ~ 1.46(9)
| 0.000*
|
SBP (mm Hg)
| ||||||||||
<120 | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
120-139 | 2F
| 14**/332 | 1.28(2)
| 0.96 ~ 1.70(2)
| 0.094 | 2R
| 81**/689 | 2.29(10)
| 1.04 ~ 5.09(10)
| 0.041*
|
≥140 | 2R
| 22**/332 | 2.39(2)
| 1.44 ~ 3.97(2)
| 0.000*
| 2R
| 30**/689 | 6.22(10)
| 2.27 ~ 17.08(10)
| 0.000*
|
Hypertension
| ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes | 5R
| 715/1,747 | 1.79(3)
| 1.39 ~ 2.30(3)
| 0.000*
| 4R
| 80**/825 | 2.84(11)
| 2.10 ~ 3.82(11)
| 0.000*
|
Diabetes
| ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes | 9R
| 667**/2,941 | 1.85(4)
| 1.43 ~ 2.38(4)
| 0.000*
| 5R
| 816**/5,860 | 1.95(12)
| 1.42 ~ 2.67(12)
| 0.000*
|
Cardiac causes
#
| ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes | 6R
| 558**/2,511 | 1.74(5)
| 1.47 ~ 2.04(5)
| 0.000*
| 1F
| 431/2,403 | 1.87(13)
| 1.45 ~ 2.42(13)
| 0.000*
|
Cardiac causes (Atrial fibrillation) | ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes | 3F
| 96**/1,062 | 1.59(6)
| 1.33 ~ 1.90(6)
| 0.000*
| 1F
| 265/2,403 | 2.30(14)
| 1.50 ~ 3.53(14)
| 0.000*
|
Smoking
| ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes△
| 10R
| 960**/3,115 | 2.05(7)
| 1.68 ~ 2.49(7)
| 0.000*
| 5R
| 350**/858 | 1.27(15)
| 1.04 ~ 1.55(15)
| 0.020*
|
Smoking (former) | 4R
| 135**/3,115 | 1.22(7)
| 0.94 ~ 1.59(7)
| 0.135 | N/A | N/A | N/A | N/A | N/A |
Smoking (Current) | 5R
| 274**/3,115 | 2.27(7)
| 1.76 ~ 2.93(7)
| 0.000*
| N/A | N/A | N/A | N/A | N/A |
Smoking (≤20 Cigarettes/d) | 3F
| 42**/3,115 | 2.31(7)
| 1.80 ~ 2.96(7)
| 0.000*
| N/A | N/A | N/A | N/A | N/A |
Smoking (>20 Cigarettes/d) | 3F
| 30**/3,115 | 2.99(7)
| 2.31 ~ 3.86(7)
| 0.000*
| N/A | N/A | N/A | N/A | N/A |
Alcohol
| ||||||||||
No | 1.000 | Ref. Group | 1.000 | Ref. Group | ||||||
Yes△
| 4F
| 537**/1,708 | 0.89(8)
| 0.76 ~ 1.04(8)
| 0.477 | 3F
| 85**/734 | 1.28(16)
| 1.07 ~ 1.53(16)
| 0.011*
|
Quality of the included studies
First author | Publication year | Selection | Comparability | Exposure |
---|---|---|---|---|
Chinese population | ||||
Yao He37
| 2003 | ★★★ | ★ | ★★ |
Xiao-Fei Zhang 42
| 2004 | ★★★ | ★★ | ★★★ |
Yan Wang53
| 2007 | ★★★ | ★ | ★ |
Wei Wang 43
| 2006 | ★★ | ★ | ★★ |
Other population | ||||
A.G.Shaper11
| 1991 | ★★★ | ★★ | ★★ |
Kathryn M. Rexrode25
| 1997 | ★★★ | ★★ | ★★ |
K. Berger28
| 1998 | ★★★ | ★★ | ★★★ |
Leon A. Simons 31
| 1998 | ★★★ | ★★ | ★★ |
P McCarron34
| 2001 | ★★★★ | ★★ | ★★★ |
Cornelia Weikert51
| 2007 | ★★★★ | ★★ | ★★★ |
Per Harmsen45
| 2006 | ★★★ | ★★ | ★★ |
Ulla Brasch Mogensen63
| 2012 | ★★★ | ★ | ★★ |
Helen Rodgers38
| 2004 | ★★★★ | ★★ | ★★★ |
George Howard60
| 2011 | ★★★ | ★★ | ★★ |
K.S. Wong33
| 1999 | ★★★★ | ★★ | ★★ |
Yun-Mi Song (a)40
| 2004 | ★★★★ | ★ | ★★★ |
Yun-Mi Song (b)41
| 2004 | ★★★★ | ★ | ★★ |
Mohsen Janghorbani47
| 2007 | ★★★★ | ★★ | ★★★ |
Truong-Minh Pham48
| 2007 | ★★★ | ★★ | ★★ |
Michiaki Kubo54
| 2008 | ★★★ | ★★ | ★★★ |
Ying Zhang56
| 2008 | ★★★★ | ★★ | ★★ |
Ulla Brasch Mogensen63
| 2012 | ★★★ | ★ | ★★ |
Risk factors | Egger's test of Western(t value) | Egger's test of Western(P) | Sensitivity analysis of Western (HR 95% CI)◎
| Sensitivity analysis of Western(HR 95% CI)◇
| Egger's test of Asian (tvalue) | Egger's test of Asian (P) | Sensitivity analysis of Asian (HR 95% CI)◎
| Sensitivity analysis of Asian (HR 95% CI)◇
|
---|---|---|---|---|---|---|---|---|
BMI (kg/ m
2
)
| ||||||||
22.0-24.9 | 1 | N/A | 1 | 1 | 1 | N/A | 1 | 1 |
18. 5–21. 9 | -1.65 | 0.240 | 0.96 (0.93 ~ 0.99)(1)
| 0.97 (0.86 ~ 1.09)(1)
| -9.52 | 0.000*
| 0.93 (0.90 ~ 0.97)(9)
| 0.97 (0.88 ~ 1.08)(9)
|
≥25.0 | -0.48 | 0.652 | 1.02 (0.99 ~ 1.05)(1)
| 1.21 (0.99 ~ 1.48)(1)
| 3.36 | 0.012*
| 1.26 (1.22 ~ 1.31)(9)
| 1.28 (1.15 ~ 1.43)(9)
|
SBP ( mm H g)
| ||||||||
<120 | 1 | 1 | 1 | N/A | 1 | 1 | ||
120-139 | N/A▲
| N/A▲
| 1.28 (0.96 ~ 1.70)(2)
| 1.28 (0.95 ~ 1.73)(2)
| N/A▲
| N/A▲
| 1.96 (1.42 ~ 2.69)(10)
| 2.30 (1.03 ~ 5.09)(10)
|
≥140 | N/A▲
| N/A▲
| 2.25 (1.74 ~ 2.92)(2)
| 2.39 (1.44 ~ 3.97)(2)
| N/A▲
| N/A▲
| 4.69 (3.37 ~ 6.52)(10)
| 6.22 (2.27 ~ 17.08)(10)
|
Hypertension
| ||||||||
No | 1 | N/A | 1 | 1 | 1 | N/A | 1 | 1 |
Yes | 1.78 | 0.173 | 1.65 (1.43 ~ 1.90)(3)
| 1.79 (1.39 ~ 2.30)(3)
| 2.01 | 0.101 | 2.66 (2.29 ~ 3.10)(11)
| 2.84 (2.10 ~ 3.82)(11)
|
Diabetes
| ||||||||
No | 1 | N/A | 1 | 1 | 1 | N/A | 1 | 1 |
Yes | 1.17 | 0.280 | 1.72 (1.52 ~ 1.94)(4)
| 1.85 (1.43 ~ 2.38)(4)
| 4.50 | 0.003*
| 2.19 (2.01 ~ 2.39)(12)
| 1.95 (1.42 ~ 2.67)(12)
|
Cardiac causes
#
| ||||||||
No | 1 | N/A | 1 | 1 | 1 | N/A | 1 | 1 |
Yes | 6.32 | 0.000*
| 1.62 (1.50 ~ 1.75)(5)
| 1.74 (1.47 ~ 2.04)(5)
| N/A▲
| N/A▲
| 1.87 (1.45 ~ 2.42)(13)
| 1.86 (1.36 ~ 2.55)(13)
|
Cardiac causes (Atrial fibrillation) | ||||||||
No | 1 | N/A | 1 | 1 | 1▲
| N/A | 1 | 1 |
Yes | 6.02 | 0.105 | 1.59 (1.33 ~ 1.90)(6)
| 1.59 (1.33 ~ 1.90)(6)
| N/A▲
| N/A▲
| 2.30 (1.50 ~ 3.53)(14)
| 2.30 (1.50 ~ 3.53)(14)
|
Smoking
| ||||||||
No | 1 | N/A | 1 | 1 | 1 | N/A | 1 | 1 |
Yes | 6.21 | 0.000*
| 1.97 (1.80 ~ 2.15)(7)
| 2.05 (1.68 ~ 2.49)(7)
| 11.39 | 0.000*
| 1.29 (1.12 ~ 1.48)(15)
| 1.27 (1.04 ~ 1.55)(15)
|
Smoking (Former) | 2.09 | 0.171 | 1.20 (1.00 ~ 1.43)(7)
| 1.22 (0.94 ~ 1.59)(7)
| N/A | N/A | N/A | N/A |
Smoking (Current) | 2.41 | 0.053 | 2.22 (1.96 ~ 2.53)(7)
| 2.27 (1.76 ~ 2.93)(7)
| N/A | N/A | N/A | N/A |
Smoking (≤20 Cigarettes/d) | -0.74 | 0.536 | 2.31 (1.80 ~ 2.96)(7)
| 2.31 (1.80 ~ 2.96)(7)
| N/A | N/A | N/A | N/A |
Smoking (>20 Cigarettes/d) | 0.73 | 0.600 | 2.99 (2.31 ~ 3.86)(7)
| 2.97 (2.16 ~ 4.09)(7)
| N/A | N/A | N/A | N/A |
Alcohol
| ||||||||
No | 1 | N/A | 1 | 1▲
| 1 | N/A | 1 | 1 |
Yes | -1.42 | 0.16 | 0.89 (0.76 ~ 1.04)(8)
| 0.92 (0.74 ~ 1.14)(8)
| 1.06 | 0.008*
| 1.28 (1.07 ~ 1.53)(16)
| 1.29 (1.07 ~ 1.57)(16)
|