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Smyth A, O'Donnell M, Rangarajan S, Hankey GJ, Oveisgharan S, Canavan M, McDermott C, Xavier D, Zhang H, Damasceno A, Avezum A, Pogosova N, Oguz A, Ryglewicz D, Iversen HK, Lanas F, Rosengren A, Yusuf S, Langhorne P. Alcohol Intake as a Risk Factor for Acute Stroke: The INTERSTROKE Study. Neurology 2023; 100:e142-e153. [PMID: 36220600 PMCID: PMC9841450 DOI: 10.1212/wnl.0000000000201388] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is uncertainty about the association between alcohol consumption and stroke, particularly for low-moderate intake. We explored these associations in a large international study. METHODS INTERSTROKE, a case-control study, is the largest international study of risk factors for acute stroke. Alcohol consumption was self-reported and categorized by drinks/week as low (1-7), moderate (7-14 for females and 7-21 for males), or high (>14 for females and >21 for males). Heavy episodic drinking (HED) was defined as >5 drinks on ≥1 day per month. Multivariable conditional logistic regression was used to determine associations. RESULTS We included 12,913 cases and 12,935 controls; 25.0% (n = 6,449) were current drinkers, 16.7% (n = 4,318) former drinkers, and 58.3% (n = 15,076) never drinkers. Current drinkers were younger, male, smokers, active, and with higher-paid occupations. Current drinking was associated with all stroke (OR 1.14; 95% CI 1.04-1.26) and intracerebral hemorrhage (ICH) (OR 1.50, 95% CI 1.21-1.84) but not ischemic stroke (OR 1.06; 95% CI 0.95-1.19). HED pattern was associated with all stroke (OR 1.39; 95% CI 1.21-1.59), ischemic stroke (OR 1.29; 95% CI 1.10-1.51), and ICH (OR 1.76; 95% CI 1.31-2.36). High level of alcohol intake was consistently associated with all stroke, ischemic stroke, and ICH. Moderate intake was associated with all stroke and ICH but not ischemic stroke. Low alcohol intake was not associated with stroke overall, but there were regional differences; low intake was associated with reduced odds of stroke in Western Europe/North America (OR 0.66; 95% CI 0.45-0.96) and increased odds in India (OR 2.18; 95% CI 1.42-3.36) (p-interaction 0.037). Wine consumption was associated with reduced odds of all stroke and ischemic stroke but not ICH. The magnitudes of association were greatest in those without hypertension and current smokers. DISCUSSION High and moderate intake were associated with increased odds of stroke, whereas low intake was not associated with stroke. However, there were important regional variations, which may relate to differences in population characteristics of alcohol consumers, types or patterns of consumption.
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Affiliation(s)
- Andrew Smyth
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
| | - Martin O'Donnell
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Sumathy Rangarajan
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Graeme J Hankey
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Shahram Oveisgharan
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Michelle Canavan
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Clodagh McDermott
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Denis Xavier
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Hongye Zhang
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Albertino Damasceno
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Alvaro Avezum
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Nana Pogosova
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Aytekin Oguz
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Danuta Ryglewicz
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Helle Klingenberg Iversen
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Fernando Lanas
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Annika Rosengren
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Salim Yusuf
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
| | - Peter Langhorne
- From the Population Health Research Institute (A.S., M.O.D., S.R., S.Y.), McMaster University and Hamilton Health Sciences, ON, Canada; HRB Clinical Research Facility Galway (A.S., M.O.D., M.C., C.M.), Department of Medicine, University of Galway, Ireland; Medical School (G.J.H.), Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; St John's Medical College and Research Institute (D.X.), Bangalore, India; Beijing Hypertension League Institute (H.Z.), China; Faculty of Medicine (A.D.), Eduardo Mondlane University, Maputo, Mozambique; Hospital Alemao Oswaldo Cruz (A.A.), Sao Paulo, Brazil; National Medical Research Center of Cardiology (N.P.), Moscow, Russia; Department of Internal Medicine (A.O.), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Military Institute of Aviation Medicine (D.R.), Warsaw, Poland; Stroke Center (H.K.I.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom
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