The Role of Atherosclerosis, Hormones and Genes in Stroke

This thesis describes the relation between atherosclerosis, hormones and genetic factors in relation to the risk of stroke. The results are based on the Rotterdam Study, a large population based cohort study among 7,983 persons aged 55 years or older. A total of 7,721 persons were free from previous stroke. The cohort was followed for morbidity, including stroke. The incidence rate increased with age and was higher in men than in women over the entire age range. We found that an increased wall thickness did not only increase the risk of stroke, but also the risk of intracerebral hemorrhage and lacunar infarction, irrespective of cardiovascular risk factors. The relevance of carotid plaques in persons without a previous stroke or TIA was not yet clear. Estradiol was not related to the risk of stroke, neither in men nor in women. Our results are in line with recent clinical trials that failed to report a beneficial effect from estrogen replacement therapy on the risk of stroke. A decreased testosterone level was related to an increased risk of stroke in men, in particular in those who did not smoke. We report that there is no clear relation between the Dallele in the angiotensin converting enzyme (ACE) gene polymorphism and risk of stroke. The relation between mutations in the hemochromatosis gene and stroke: two mutations (C282 and H63D) were related to the risk of stroke and increased carotid intima-media thickness in persons who smoked or had hypertension.

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