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Influence of Cardiovascular Fitness and Muscle Strength in Early Adulthood on Long-Term Risk of Stroke in Swedish Men

Journal article
Authors N David Åberg
Hans-Georg Kuhn
Jenny Nyberg
Margda Waern
Peter Friberg
Johan Svensson
Kjell Torén
Annika Rosengren
Maria A I Åberg
Michael Nilsson
Published in Stroke
Volume 46
Issue 7
Pages 1769-1776
ISSN 0039-2499
Publication year 2015
Published at Institute of Neuroscience and Physiology
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Institute of Medicine, Department of Public Health and Community Medicine
Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1769-1776
Language en
Links dx.doi.org/10.1161/strokeaha.115.00...
Keywords epidemiology, exercise, incidence, muscles, stroke, PHYSICAL-ACTIVITY, AEROBIC FITNESS, ISCHEMIC-STROKE, POPULATION, YOUNG, METAANALYSIS, EXERCISE, OUTCOMES, TRENDS, LEVEL, Clinical Neurology, Peripheral Vascular Disease
Subject categories Neurology

Abstract

Background and Purpose Low cardiovascular fitness (fitness) in mid- and late life is a risk factor for stroke. However, the respective effects on long-term stroke risk of fitness and muscle strength in early adulthood are unknown. Therefore, we analyzed these in a large cohort of young men. Method We performed a population-based longitudinal cohort study of Swedish male conscripts registered in 1968 to 2005. Data on fitness (by the cycle ergometric test; n=1 166 035) and muscle strength (n=1 563 750) were trichotomized (low, medium, and high). During a 42-year follow-up, risk of stroke (subarachnoidal hemorrhage, intracerebral hemorrhage, and ischemic stroke) and fatality were calculated with Cox proportional hazards models. To identify cases, we used the International Classification of Diseases-Eighth to Tenth Revision in the Hospital Discharge Register and the Cause of Death Register. Results First-time stroke events were identified (subarachnoidal hemorrhage, n=895; intracerebral hemorrhage, n=2904; ischemic stroke, n=7767). For all stroke and fatality analysis any type of first-time stroke was recorded (n=10 917). There were inverse relationships in a dose-response fashion between fitness and muscle strength with any stroke (adjusted hazard ratios for the lowest, compared with the highest, tertile of each 1.70 [1.50-1.93] and 1.39 [1.27-1.53], respectively). There were stronger associations for fatal stroke. All 3 stroke types displayed similar associations. Associations between fitness and stroke remained when adjusted for muscle strength, whereas associations between muscle strength and stroke weakened/disappeared when adjusted for fitness. Conclusions At the age of 18 years, low fitness and to a lesser degree low muscle strength were independently associated with an increased future stroke risk.

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