SCORING SYSTEM TO IDENTIFY MEN AT HIGH-RISK OF STROKE - A STRATEGY FOR GENERAL-PRACTICE

Background. The major risk factors for stroke are well described and t here is good evidence that the risk associated with hypertension and c igarette smoking are reversible by appropriate interventions. However, if disease prevention measures are to be efficient, it is important t hat a system which can identify individuals at high risk of stroke be available for use in general practice.Aim. A study was therefore under taken to design an effective and practical system for detecting men ag ed 40 to 59 years at high risk of stroke in primary care. Method. Stro ke incidence and risk factor data were examined in a cohort of 7735 me n aged 40 to 59 years who had taken part in the British regional heart study. Analysis was performed using data from initial entry into the study and then from five and 11.5 years of follow up. Subjects were ra ndomly selected from the age-sex register of one general practice in e ach of 24 different towns throughout the United Kingdom, representing the full range of cardiovascular mortality rates. Results. A simple sc oring system derived from logistic regression using age, systolic bloo d pressure, current cigarette consumption, and evidence of anginal che st pain was able to detect more than 80% of all strokes occurring with in five years in the top fifth of the score distribution. The inclusio n of other risk factors for stroke did not increase the score's predic tive ability. The combination of smoking and hypertension, while much less sensitive than the scoring system, was a better indicator of risk than any single risk factor, all of whose predictive values were poor . Conclusion. Based on readily measured variables, this scoring system could be used in general practice to identify men at high risk of str oke who would benefit from further intervention. Effective identificat ion of high risk individuals requires assessment of the combined effec ts of multiple risk factors.