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Objective To investigate the influence of increasing age on the incidence and remaining lifetime risk of cardiovascular disease and cancer in a cohort of older men. Design Prospective cohort study. Setting United States. Participants 22 048 male doctors aged 40-84 who were free of major disease in 1982. Main outcome measures Incidence and remaining lifetime risk of major cardiovascular disease (myocardial infarction, stroke, and death from cardiovascular disease) and cancer. Results 3252 major cardiovascular events and 5400 incident cancers were confirmed over 23 years of follow- up. The incidence of major cardiovascular disease continued to increase to age 100. Beginning at age 80, however, major cardiovascular disease was more likely to be diagnosed at death. The incidence of cancer peaked in those aged 80-89 and then declined. Cancers detected by screening accounted for most of the decline, whereas most cancers for which there was no screening continued to increase to age 100. Unadjusted cumulative incidence overestimated the risk of cardiovascular disease by 16% and cancer by 8.5%. The remaining lifetime risk of cancer at age 40 was 45.1% (95% confidence interval 43.8% to 46.3%) and at age 90 was 9.6% (7.2% to 11.9%). The remaining lifetime risk of major cardiovascular disease at age 40 was 34.8% (33.1% to 36.5%) and at age 90 was 167% (12.9% to 20.6%). Conclusions In this prospective cohort of men, the incidence of new cardiovascular disease continued to increase after age 80 but was most often diagnosed at death. The decrease in incidence of cancer late in life seemed largely due to a decline in cancers usually detected by screening. These findings suggest that people aged 80 and older have a substantial amount of undiagnosed disease. The remaining lifetime risk of both diseases approached a plateau in the 10th decade. This may be due to decreased detection of disease and reporting of symptoms and increased resistance to disease in those who survive to old age. Accurate estimates of disease risk in an aging population require adjustment for competing risks of mortality. [ABSTRACT FROM AUTHOR]

Objective To investigate risk factors, such as heavy alcohol consumption, that might explain any increased risk of haemorrhagic stroke associated with low blood cholesterol. Design Prospective cohort study. Setting Korea. Participants 787 442 civil servants (661 700 men, 125 742 women) aged 30-64. Main outcome measures Cardiovascular risk factors were assessed at biennial health check. Data on morbidity and mortality were ascertained from 1990 to 2001 using hospital admissions and mortality surveillance systems. Results 6328 cases of ischaemic stroke (6021 men, 307 women), 3947 cases of haemorrhagic stroke (3748 men, 199 women), 3170 cases of undefined stroke (2902 men, 268 women), and 4417 cases of myocardial infarction (4305 men, 112 women) occurred. Ischaemic stroke and myocardial infarction were strongly and positively associated with blood cholesterol (hazard ratio per 1 mmol/l cholesterol 1.20 (95% confidence 1.16 to 1.24) and 1.48 (1.43 to 1.53), respectively). Haemorrhagic stroke showed an inverse association in fully adjusted models (0.91, 0.87 to 0.95). This inverse association was confined to participants with hypertension. When stratified by concentration of ϒ glutamyl transferase (GGT), an indicator of alcohol consumption, the association was not seen in participants with low concentrations of GGT, and it was independent of hypertension in those with high concentrations of GGT (> 80 U/l). [ABSTRACT FROM AUTHOR]

The article examines the heightened risk of thrombotic events, such as myocardial infarction and stroke, for people using non-steroidal anti-inflammatory drugs, especially selective cyclo-oxygenase-2 (COX 2) inhibitors. Two selective COX 2 inhibitors are no longer available. Patients who have a risk of cardiovascular complications should not be treated with COX 2 inhibitors.

Objective To investigate the relation between access to a cardiac catheterisation laboratory and clinical outcomes in patients admitted to hospital with suspected acute coronary syndrome. Design Prospective, multinational, observational registry. Setting Patients enrolled in 106 hospitals in 14 countries between April 1999 and March 2003. Participants 28 825 patients aged 18 years. Main outcome measures Use of percutaneous coronary intervention or coronary artery bypass graft surgery, death, infarction after discharge, stroke, or major bleeding. Results Most patients (77%) across all regions (United States, Europe, Argentina and Brazil, Australia, New Zealand, and Canada) were admitted to hospitals with catheterisation facilities. As expected, the availability of a catheterisation laboratory was associated with more frequent use of percutaneous coronary intervention (41% v 3.9%, P < 0.001) and coronary artery bypass graft (7.1% v 0.7%, P< 0.001). After adjustment for baseline characteristics, medical history, and geographical region there were no significant differences in the risk of early death between patients in hospitals with or without catheterisation facilities (odds ratio 1.13, 95% confidence interval 0.98 to 1.30, for death in hospital; hazard ratio 1.05, 0.93 to 1.18, for death at 30 days). The risk of death at six months was significantly higher in patients first admitted to hospitals with catheterisation facilities (hazard ratio 1.14, 1.03 to 1.26), as was the risk of bleeding complications in hospital (odds ratio 1.94, 1.57 to 2.39) and stroke (odds ratio 1.53, 1.10 to 2.14). Conclusions These findings support the current strategy of directing patients with suspected acute coronary syndrome to the nearest hospital with acute care facilities, irrespective of the availability of a catheterisation laboratory, and argue against early routine transfer of these patients to tertiary care hospitals with interventional facilities. [ABSTRACT FROM AUTHOR]

Objective To compare the incidence of admissions to hospital for stroke among older adults with dementia receiving atypical or typical antipsychotics. Design Population based retrospective cohort study. Setting Ontario, Canada. Patients 32 710 older adults (65 years) with dementia (17 845 dispensed an atypical antipsychotic and 14 865 dispensed a typical antipsychotic). Main outcome measures Admission to hospital with the most responsible diagnosis (single most important condition responsible for the patient's admission) of ischaemic stroke. Observation of patients until they were either admitted to hospital with ischaemic stroke, stopped taking antipsychotics, died, or the study ended. Results After adjustment for potential confounders, participants receiving atypical antipsychotics showed no significant increase in risk of ischaemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01, 95% confidence interval 0.81 to 1.26). This finding was consistent in a series of subgroup analyses, including ones of individual atypical antipsychotic drugs (risperidone, olanzapine, and quetiapine) and selected subpopulations of the main cohorts. Conclusion Older adults with dementia who take atypical antipsychotics have a similar risk of ischaemic stroke to those taking typical antipsychotics. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between intake of total fat, specific types of fat, and cholesterol and risk of stroke in men. Design and setting: Health professional follow up study with 14 year follow up. Participants: 43 732 men aged 40-75 years who were free from cardiovascular diseases and diabetes in 1986. Main outcome measure: Relative risk of ischaemic and haemorrhagic stroke according to intake of total fat, cholesterol, and specific types of fat. Results: During the 14 year follow up 725 cases of stroke occurred, including 455 ischaemic strokes, 125 haemorrhagic stokes, and 145 strokes of unknown type. After adjustment for age, smoking, and other potential confounders, no evidence was found that the amount or type of dietary fat affects the risk of developing ischaemic or haemorrhagic stroke. Comparing the highest fifth of intake with the lowest fifth, the multivariate relative risk of ischaemic stroke was 0.91 (95% confidence interval 0.65 to 1.28; P for trend = 0.77) for total fat, 1.20 (0.84 to 1.70; P= 0.47) for animal fat, 1.07 (0.77 to 1.47; P = 0.66) for vegetable fat, 1.16 (0.81 to 1.65; P = 0.59) for saturated fat, 0.9 (0.65 to 1.28; P = 0.83) for monounsaturated fat, 0.88 (0.64 to 1.21; P=0.25) for polyunsaturated fat, 0.87 (0.62 to 1.22; P = 0.42) for trans unsaturated fat, and 1.02 (0.75 to 1.39; P = 0.99) for dietary cholesterol. Intakes of red meats, high fat dairy products, nuts, and eggs were also not appreciably related to risk of stroke. Conclusions: These findings do not support associations between intake of total fat, cholesterol, or specific types of fat and risk of stroke in men. [ABSTRACT FROM AUTHOR]

Examines the relation between cigarette smoking and stroke. Conduction of meta-analysis; Estimation on the individual relative risks to weight; Risk of stroke among cigarette smokers.

Determines whether migraine is a risk factor for ischemic stroke in young women. Main outcome measures; Effect of oral contraceptive use and smoking.

Investigates the extent to which geographical variations in mortality from ischemic heart disease and stroke in Great Britain are influenced by factors in early life or in adulthood. Genetic factors; Environmental exposures; Lifestyle.

Evaluation of avoidable factors in deaths from stroke and hypertensive disease in Great Britain. Analysis of cases of important avoidable factors; Details on the interassessor and intra-assessor agreement on cause of death; Rate of deaths caused by cerebrovascular disease.

Determines risk factors for stroke in middle aged British men. Relation between blood pressure and stroke; Effects of cigarette smoking; Increase in risk of stroke due to heavy drinking of alcohol.

Examines the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district. Prevalence of hypertension; Definition of hypertension use din the study; Stroke register.

The article presents an overview of the methods which can be used to manage anticoagulated patients with atrial fibrillation who are at a high risk of stroke and who need coronary intervention. A discussion of research which has been done on side effects which are associated with therapeutics that are commonly used on atrial fibrillation patients is presented. Advice and information for physicians who are managing a patient with atrial fibrillation who is at a high risk of stroke and is in need of cardiac intervention is offered.

Objectives To investigate the association between use of typical and atypical antipsychotic drugs and incidence of stroke in patients with and without dementia. Design Self controlled case series. ¦Setting UK based electronic primary care records in the general practice research database (GPRD). Participants All patients registered in the database with a recorded incident stroke and at least one prescription for any antipsychotic drug before the end of 2002: 6790 eligible participants were identified and included in the final analysis. Main outcome measures Rate ratio for stroke in periods of time exposed to antipsychotics compared with unexposed periods. Results Use of any antipsychotic drug was associated with a rate ratio for stroke of 1.73 (95% confidence interval 1.60 to 1.87): 1.69 (1.55 to 1.84) fortypical antipsychotics and 2.32 (1.73 to 3.10) for atypical antipsychotics. In patients receiving any antipsychotic drug, the rate ratios were 3.50 (2.97 to A.12) forthose with dementia and 1.41 (1.29 to 1.55) forthose without dementia. Conclusions All antipsychotics are associated with an increased risk of stroke, and the risk might be higher in patients receiving atypical antipsychotics than those receiving typical antipsychotics. People with dementia seem to be at a higher risk of an associated stroke than people without dementia and use of antipsychotics should, when possible, be avoided in these patients. [ABSTRACT FROM AUTHOR]

Objectives To review completed trials assessing effect of hormone replacement therapy on subsequent risk of stroke, assessing stroke by pathological type, severity, and outcome. Design Systematic review of randomized controlled trials identified from the Cochrane Library, Embase, and Medline; reviews; and reference lists of relevant papers. Studies reviewed 28 trials, with 39 769 subjects, were identified. Review measures Rates for cerebrovascular events analysed with a random effects model. Sensitivity analyses for heterogeneity included phase of prevention (primary or secondary), type of hormone replacement therapy (oestrogen alone or combined with progesterone), type of oestrogen (estradiol or conjugated equine oestrogen), size of trial (< 5000 or > 5000 patients), length of follow up (£3 years or > 3 years), sex (women only or men only), and trial quality (high or low). Results Hormone replacement therapy was associated with significant increases in total stroke (odds ratio 1.29 (95% confidence interval 1.13 to 1.47), n = 28), non-fatal stroke (1.23 (1.06 to 1.44), n = 21), stroke leading to death or disability (1.56 (1.11 to 2.20), n = 14), ischaemic stroke (1.29 (1.06 to 1.56), n = 16), and a trend to more fatal stroke (1.28 (0.87 to 1.88), n = 22). It was not associated with haemorrhagic stroke (1.07 (0.65 to 1.75), n = 17) or transient ischaemic attack (1.02 (0.78 to 1.34), n = 22). Statistical heterogeneity was not present in any analysis. Conclusions Hormone replacement therapy was associated with an increased risk of stroke, particularly of ischaemic type. Among subjects who had a stroke, those taking hormone replacement therapy seemed to have a worse outcome. Hormone replacement therapy cannot be recommended for the primary or secondary prevention of stroke.. [ABSTRACT FROM AUTHOR]

Objective To explore the association between migraine and risk of ischaemic stroke. Design Systematic review and meta-analysis. Data sources Observational studies published between 1966 and June 2004 (identified through Medline and Embase) that examined the association between migraine and risk of ischaemic stroke. Results 14 studies (11 case-control studies and 3 cohort studies) were identified. These studies suggest that the risk of stroke is increased in people with migraine (relative risk 2.16, 95% confidence interval 1.89 to 2.48). This increase in risk was consistent in people who had migraine with aura (relative risk 2.27, 1.61 to 3.19) and migraine without aura (relative risk 1.83, 1.06 to 3.15), as well as in those taking oral contraceptives (relative risk 8.72, 5.05 to 15.05). Conclusions Data from observational studies suggest that migraine may be a risk factor in developing stroke. More studies are needed to explore the mechanism of this potential association. In addition, the risk of migraine among users of oral contraceptives must be further investigated.. [ABSTRACT FROM AUTHOR]

The article focuses on research which looked at the role atherosclerotic plaque plays in both acute coronary syndromes and ischaemic stroke. Researchers have found that unstable atherosclerotic plaque leads to thrombosis which is the main cause of acute coronary syndromes. In addition, plaque has been found to be the cause of a large percentage of strokes but both stable and unstable plaque has been found to be responsible. A discussion of the need for more thorough investigation of patients to find plaque and prevent strokes and coronary syndromes is presented.

The article presents an editorial regarding the high stroke mortality in Bangladeshi populations in Great Britain. The editor responds to a paper by Wild et al. titled "Persistence of substantial inequalities in cardiovascular disease mortality by country of birth in England and Wales 2001-2003." Bangladeshi men tend to have a high prevalence of diabetes, smoking, physical inactivity and other risk factors. The editor suggests that researchers investigate squatting and straining at stool, vitamin D deficiency, infection, and the impact of smoking and chewing tobacco as reasons why Bangladeshi have high stroke mortality.

Presents the results of a study on mortality associated with passive smoking in Hong Kong. Participants, methods and results of the study; What this study adds to the knowledge of the relationship between passive smoke and higher risks for stroke, COPD, lung cancer and heart disease; Comments from the authors.

Presents an editorial on two papers in this issue that offer more evidence on the risks of second-hand smoke. Study which found that cotinine concentrations are not good markers of lung cancer risk; Study which suggests that passive smoking increases the risk of stroke; Limitations of the studies; Belief they add little to what is already known and are unlikely to change policy on smoke free places.

Presents an editorial on a paper in this issue on migraine and ischaemic stroke. Report which suggests an association between migraine sufferers and increased risk of stroke; Caution that the figures may not be accurate and the reasons for that; Belief that older people with migraines may need to be assessed more carefully than younger victims; Some medical conditions associated with an increase in the risk of stroke which can also cause migraine; How neither stroke or migraine are just single diseases; Suggestions for clinical treatment of migraine with particular interest in the use of oral contraceptives.

Reports on a study to gather evidence for an inverse association between impaired fetal growth and occlusive and hemorrhagic stroke. Participants; Methods; Results; Conclusion that impaired fetal growth is strongly associated with hemorrhagic stroke but not with occlusive stroke.

Reports on a study to estimate the general practice workload involved in meeting the goals of Great Britain's national service framework for coronary heart disease. Goal of the framework to identify all patients at risk for coronary heart disease and stroke and offer appropriate treatment; Participants; Methods; Results; Conclusion.

Focuses on a study which compared the outcomes and the identification and documentation of known risk factors in a cohort of patients admitted with a stroke or having a stroke while in hospital. Description of the study participants; How the study was conducted; Results; Comments on the study.

The article presents a quiz regarding the relative risk of stroke in hospital care versus organised care.

The article reports on the results of research which was done on the C reactive protein and was reported in the "New England Journal of Medicine". Researchers found that high concentrations of C reactive protein were associated with a 60% increase in the risk of heart disease and a 30% increase in the risk of cerebrovascular disease. Researchers also found that while four genetic polymorphisms were associated with raised serum concentrations of C reactive proteins, the polymorphisms failed to predict either heart disease or cerebrovascular disease.

The article presents news items related to medicine. Reports in "AIDS Care" found that HIV testing in Vietnam seems to be more acceptable when it comes under the qualification of routine blood tests that are carried out in clinics or a state hospital. Research reported in "Pediatrics" found that multiple courses of oral steroids given to asthmatic children over the course of several years can produce a dose dependent reduction in bone mineral density and a greater risk of osteopenia in boys. Research found in "Stroke" indicates that depression in old age may increase the risk of stroke.

The article presents medical news briefs. An increase in the rate of euthanasia in Belgium is discussed. The European Commission will fund a publicly accessible web site that will list the sources of stem cell lines and clinical trials involving stem cell research in the European Union. Scientists led by Magdi Yacoub, a professor of cardiac surgery, grew part of a human heart from stem cells. A study found that people with hemochromatosis, a genetic mutation, are more likely to suffer a stroke than other people.

The article presents a review of material published in various medical publications associated with the "British Medical Journal." Statins are shown to be beneficial in community based patients with ischaemic heart disease. Nicotine replacement is not a risk for stroke or myocardial infarction. Congenital abnormality has been found to be uncommon in fetuses exposed to antiepileptics. A medical survey found that most people would trust doctors if euthanasia was legalized.

This article discusses a decision made by the U.S. Food and Drug Administration (FDA) to place warning labels on the packages of several different stimulant drugs used to treat attention-deficit/hyperactivity disorder. The warnings are to alert consumers of the stimulants' association with rises in blood pressure and heart rate, increasing the risk of heart attacks and strokes. However, some FDA officials worry that the warnings will prevent some patients from taking the medications, even if they need them. No long-term clinical studies have been conducted examining effects of these stimulants on the heart.

Presents the results of a study on the impact of aspirin on the risk for cardiovascular disease in women. Details of the study, which focused on middle-aged women with no history of cardiovascular disease; Details of the study's outcome; Report that aspirin reduces the risk of stroke and transient ischemic attack in women, but does not reduce the risk of myocardial infarction or cardiovascular death.

Presents corrections and clarifications to articles in previous issues. "Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm"; "Risk of ischaemic stoke in people with migraine:systematic reviews and meta-analysis of observational studies"; "Minerva."

Reports that an advisory panel to the United States Food and Drug Administration has recommended that the drugs rofecoxib, celecoxib and valdecoxib carry black box warnings on the increased risk of heart attack and stroke but did not recommend the drugs be withdrawn from the market. Media coverage of the panel's findings which have been distorted in the opinion of Alastair Wood, the chairman of the panel who said almost 50% of the panel recommended pulling two drugs from the market; Similar findings which have been discovered by Australian and European authorities.

Examines the link found in Taiwan between air pollution coupled with warm weather and ischaemic and haemorrhagic strokes. Study results showing how many stroke victims have been affected by air pollution and warm weather; Relation between hot weather and pollution, including its health effects; Profile of the city of Kaohsiung, the city where the study was done; Possible explanations of how the pollution and weather factors could be a cause of strokes.

Reports on the discovery of the risk of hemorrhagic stroke among women who take medications containing phenylpropanolamine (PPA). Vote of the United States Food and Drug Administration (FDA) to ban PPA in non-prescription decongestants and appetite suppressants; Details of proprietary medicines that contain PPA; Design of the case-control study in which the risk of stroke was found.

Examines the risk of stroke in patients with cerebrovascular disease. Lowering of blood pressure in patients with ischemic cerebrovascular disease; Association of blood pressure and recurrent stroke.