Impact of preventable risk factors on stroke in the EPICOR study: does gender matter?

Objectives: The effect of modifiable stroke risk factors in terms of prevented cases remains unclear due to sex-specific disease rate and risk factors prevalence. Our aim was to estimate their impact on stroke by gender through population-attributable fraction (PAF), preventive fraction (PF) and their combination in EPIC-Italian cohort. Methods: 43,976 participants, age 34–75, and free of cardiovascular disease at baseline (1993–1998) were followed up for almost 11 years. Adjusted hazard ratios and PAF were estimated using Cox models. Results: We identified 386 cases. In males, the burden for stroke was 17% (95% CI 4–28%) for smoking and 14% (95% CI 5–22%) for alcohol consumption. In females, hypertension was carrying the biggest burden with 18% (95% CI 9–26%) followed by smoking 15% (95% CI 7–22%). Their combination was 46% (95% CI 32–58%) in males and 48% (95% CI 35–59%) in females. PF for current smokers was gender unequal [males 21% (95% CI 15–27%) females 9% (95% CI 1–17%)]. Conclusions: Half of strokes are attributable to potentially modifiable factors. The proportion of prevented cases is gender unbalanced, encouraging sex-specific intervention.