scholarly journals LITERATURE REVIEW: RISK FACTORS OF INCREASING TUBERCULOSIS INCIDENCE

2021 ◽  
Vol 16 (1) ◽  
pp. 106-113
Author(s):  
Joko Sapto Pramono
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Close Contact ◽  
Google Scholar ◽  
Social Contacts ◽  
Increased Risk ◽  
The Family ◽  
Family Level ◽  
History Of ◽  
And Behavior

ABSTRACT   Globally, the incidence of Tuberculosis was still quite high, there were an estimated that 10 million people are infected with Tuberculosis and even 44% of cases are in Southeast Asia, Indonesia was in the 2nd position in the world after India and every year it is still increasing. Tuberculosis is transmitted through droplets of sufferers when coughing or sneezing, close contact is very vulnerable to the transmission process in addition to other supporting factors. This paper aims to review various sources regarding the risk factors for an increase in the incidence of tuberculosis. The method used was literature review sourced from the Google scholar, ScienceDirect, and ProQuest database as well as other sources such as textbooks and reports published in 2015 to 2020. The results of the literature review showed that most of the risk factors for the incidence of tuberculosis were a history of close contact, age, gender, lifestyle and behavior. Meanwhile, the factors that contribute to the increased risk are occupancy density, ventilation and house lighting, as well as factors for decreased immune system including nutritional status and comorbidities, although at the age of 0-5 years who have received BCG immunization, they were still susceptible to primary tuberculosis infection. Controlling the increased incidence of tuberculosis should be directed at preventing transmission, especially at the family level and   close social contacts as well as increasing awareness of correct coughing and sputum behavior. Key words: risk factors; incidence; tuberculosis     ABSTRAK   Serara global angka insidensi Tuberkulosis dunia   masih cukup tinggi, diperkirakan 10 juta   orang  terinfeksi tuberkulosis bahkan 44% kasus  berada di  Asia Tenggara, Indonesia pada posisi rangking   ke-2 dunia setelah India  dan setiap tahun masih meningkat. Tuberkulosis ditularkan melalui droplet  penderita saat batuk atau bersin, kontak dekat menjadi sangat rentan terjadinya proses penularan disamping faktor-faktor lain yang menunjang.  Tulisan  ini bertujuan untuk mengulas berbagai sumber mengenai faktor risiko peningkatan angka insidensi Tuberkulosis. Metode yang digunakan adalah  tinjauan literatur    yang bersumber dari  database Google scholar, ScienceDirect, dan ProQuest   selain itu juga sumber lainnya seperti buku ajar dan laporan yang diterbitkan pada tahun 2015 hingga 2020.  Hasil tinjauan literatur menunjukkan sebagian besar faktor risiko angka insidensi Tuberkulosis adalah riwayat kontak erat, usia, jenis kelamin,  gaya hidup dan perilaku. Sementara faktor yang menunjang peningkatan risiko adalah kepadatan hunian, ventilasi dan pencahayaan rumah, begitu pula faktor penurunan daya tahan tubuh meliputi status gizi dan  penyakit penyerta, walaupun pada usia 0-5 tahun yang telah mendapatkan imunisasi BCG, namun masih rentan terinfeksi Tuberkulosis primer.   Hendaknya  pengendalaian peningkatan insidensi Tuberkulosis   diarahkan pada pencegahan penularan khususnya di tingkat keluarga  dan kontak sosial dekat serta peningkatan kesadaran perilaku batuk dan membuang dahak yang benar. Kata kunci: Faktor risiko; insidensi; tuberkulosis

Suicide and assisted dying in dementia: what we know and what we need to know. A narrative literature review

2017 ◽  
Vol 29 (8) ◽  
pp. 1247-1259 ◽  
Author(s):  
J. Diehl-Schmid ◽  
R. Jox ◽  
S. Gauthier ◽  
S. Belleville ◽  
E. Racine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Cochrane Library ◽  
Assisted Dying ◽  
Increased Risk ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
And Behavior ◽  
The Impact ◽  
Risk Factors For Suicide

ABSTRACTBackground:Evidence-based data on prevalence and risk factors of suicidal intentions and behavior in dementia are as scarce as the data on assisted dying. The present literature review aimed on summarizing the current knowledge and provides a critical discussion of the results.Methods:A systematic narrative literature review was performed using Medline, Cochrane Library, EMBASE, PSYNDEX, PSYCINFO, Sowiport, and Social Sciences Citation Index literature.Results:Dementia as a whole does not appear to be a risk factor for suicide completion. Nonetheless some subgroups of patients with dementia apparently have an increased risk for suicidal behavior, such as patients with psychiatric comorbidities (particularly depression) and of younger age. Furthermore, a recent diagnosis of dementia, semantic dementia, and previous suicide attempts most probably elevate the risk for suicidal intentions and behavior. The impact of other potential risk factors, such as patient's cognitive impairment profile, behavioral disturbances, social isolation, or a biomarker based presymptomatic diagnosis has not yet been investigated. Assisted dying in dementia is rare but numbers seem to increase in regions where it is legally permitted.Conclusion:Most studies that had investigated the prevalence and risk factors for suicide in dementia had significant methodological limitations. Large prospective studies need to be conducted in order to evaluate risk factors for suicide and assisted suicide in patients with dementia and persons with very early or presymptomatic diagnoses of dementia. In clinical practice, known risk factors for suicide should be assessed in a standardized way so that appropriate action can be taken when necessary.

scholarly journals Peranan Faktor Lingkungan dan Kontributor Selama Kehamilan terhadap Hipospadia

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ester J. Tuju ◽  
Harsali F. Lampus ◽  
Stephanus J. Ch. Tangel
Keyword(s):  
Risk Factors ◽  
Environmental Factors ◽  
Literature Review ◽  
Maternal Age ◽  
Strong Relationship ◽  
First Trimester ◽  
Google Scholar ◽  
Increased Risk ◽  
Review Study ◽  
The Relationship

Abstract: The etiology of hypospadias is not certainly known and is still controversial. Environmental factors and their influence during pregnancy can be risk factors for increased incidence of hypospadias. This study was aimed to obtain the risk factors of hypospadias. This was a literature review study using three databases, as follows: ClinicalKey, PubMed, and Google Scholar. There were 47 literatures in this study. The results showed that from the 47 literatures containing risk factors of hypospadias, 8 literatures reported the relationship between pesticides and hypospadias; 3 literatures reported the relationship between smoking and increased risk of hypospadias; 6 literatures revealed that there was a strong relationship between maternal age and increased risk of hypospadias; 8 literatures showed that low births weight babies were associated with hypospadias and placental insufficiency as its cause; 5 literatures stated that several drugs consumed by pregnant women during the first trimester were related to the increased risk of hypospadias. In conclusion, environmental factors and contributors during pregnancy are the risk factors of hypospadias.Keywords: hypospadias, risk factors, environmental factors, contributors during pregnancy Abstrtrak: Etiologi hipospadia belum diketahui dengan pasti dan masih bersifat kontroversial. Faktor lingkungan serta hal yang berpengaruh selama kehamilan dapat menjadi faktor risiko peningkatan kejadian hipospadia. Penelitian ini bertujuan untuk mengetahui faktor risiko hipospadia. Jenis penelitian ialah literature review dengan menggunakan database ClinicalKey, PubMed, dan Google Scholar. Hasil penelitian mendapatkan bahwa dari 47 literatur yang memuat tentang faktor risiko hipospadia, 8 literatur memuat adanya hubungan antara pestisida dengan hipospadia, 3 literatur memuat bahwa merokok berkaitan dengan peningkatan risiko hipospadia, 6 literatur memuat bahwa usia ibu memiliki hubungan kuat dengan peningkatan risiko hipospadia, 8 literatur memuat bahwa bayi berat lahir rendah berkaitan dengan hipospadia dan insufisiensi plasenta menjadi penyebab terjadinya hal tersebut, 5 literatur memuat bahwa beberapa obat obatan yang dikonsumsi ibu hamil selama trimester pertama berkaitan dengan peningkatan risiko hipospadia. Simpulan penelitian ini ialah faktor lingkungan dan kontributor selama kehamilan merupakan faktor risiko hipospadia.Kata kunci: hipospadia, faktor risiko, factor lingkungan, Kontributor selama kehamilan

scholarly journals Childhood and family influences on body mass index in early adulthood: findings from the Ontario Child Health Study

2021 ◽  
Author(s):  
Andrea Gonzalez ◽  
Michael H. Boyle ◽  
Katholiki Georgiades ◽  
Laura Duncan ◽  
Leslie R. Atkinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Child Health ◽  
Family Functioning ◽  
Body Mass ◽  
Early Adulthood ◽  
Health Study ◽  
The Family ◽  
Family Level ◽  
History Of

Background Overweight and obesity are steadily increasing worldwide with the greatest prevalence occurring in high-income countries. Many factors influence body mass index (BMI); however multiple influences assessed in families and individuals are rarely studied together in a prospective design. Our objective was to model the impact of multiple influences at the child (low birth weight, history of maltreatment, a history of childhood mental and physical conditions, and school difficulties) and family level (parental income and education, parental mental and physical health, and family functioning) on BMI in early adulthood. Methods We used data from the Ontario Child Health Study, a prospective, population-based study of 3,294 children (ages 4–16 years) enrolled in 1983 and followed up in 2001 (N = 1,928; ages 21–35 years). Using multilevel models, we tested the association between family and child-level variables and adult BMI after controlling for sociodemographic variables and health status in early adulthood. Results At the child level, presence of psychiatric disorder and school difficulties were related to higher BMI in early adulthood. At the family level, receipt of social assistance was associated with higher BMI, whereas family functioning, having immigrant parents and higher levels of parental education were associated with lower BMI. We found that gender moderated the effect of two risk factors on BMI: receipt of social assistance and presence of a medical condition in childhood. In females, but not in males, the presence of these risk factors was associated with higher BMI in early adulthood. Conclusion Overall, these findings indicate that childhood risk factors associated with higher BMI in early adulthood are multi-faceted and long-lasting. These findings highlight the need for preventive interventions to be implemented at the family level in childhood.

scholarly journals Childhood and family influences on body mass index in early adulthood: findings from the Ontario Child Health Study

2021 ◽  
Author(s):  
Andrea Gonzalez ◽  
Michael H. Boyle ◽  
Katholiki Georgiades ◽  
Laura Duncan ◽  
Leslie R. Atkinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Child Health ◽  
Family Functioning ◽  
Body Mass ◽  
Early Adulthood ◽  
Health Study ◽  
The Family ◽  
Family Level ◽  
History Of

Background Overweight and obesity are steadily increasing worldwide with the greatest prevalence occurring in high-income countries. Many factors influence body mass index (BMI); however multiple influences assessed in families and individuals are rarely studied together in a prospective design. Our objective was to model the impact of multiple influences at the child (low birth weight, history of maltreatment, a history of childhood mental and physical conditions, and school difficulties) and family level (parental income and education, parental mental and physical health, and family functioning) on BMI in early adulthood. Methods We used data from the Ontario Child Health Study, a prospective, population-based study of 3,294 children (ages 4–16 years) enrolled in 1983 and followed up in 2001 (N = 1,928; ages 21–35 years). Using multilevel models, we tested the association between family and child-level variables and adult BMI after controlling for sociodemographic variables and health status in early adulthood. Results At the child level, presence of psychiatric disorder and school difficulties were related to higher BMI in early adulthood. At the family level, receipt of social assistance was associated with higher BMI, whereas family functioning, having immigrant parents and higher levels of parental education were associated with lower BMI. We found that gender moderated the effect of two risk factors on BMI: receipt of social assistance and presence of a medical condition in childhood. In females, but not in males, the presence of these risk factors was associated with higher BMI in early adulthood. Conclusion Overall, these findings indicate that childhood risk factors associated with higher BMI in early adulthood are multi-faceted and long-lasting. These findings highlight the need for preventive interventions to be implemented at the family level in childhood.

Human directed aggression in Brazilian domestic cats: Owner reported prevalence, contexts and risk factors

2009 ◽  
Vol 11 (10) ◽  
pp. 835-841 ◽  
Author(s):  
Daniela Ramos ◽  
Daniel Simon Mills
Keyword(s):  
Risk Factors ◽  
Background Activity ◽  
Public Health Problem ◽  
Future Research ◽  
Pet Attachment ◽  
Increased Risk ◽  
The Family ◽  
Potential Risk Factors ◽  
History Of ◽  
Early Trauma

Aggression by cats towards humans is a serious behavioural, welfare and public health problem, although owners may believe it is an inevitable part of cat ownership. There has been little scientific investigation of the risk factors associated with this problem. One hundred and seven owners in the Sao Paulo region of Brazil, took part in a survey aimed at investigating the perceived prevalence of the problem, defining the most common contexts of human directed aggression and identifying associated potential risk factors. Human directed aggression occurred in 49.5% of cats and was most commonly associated with situations involving petting and play, followed by protection of a resource, when startled, when observing an unfamiliar animal and least commonly when unfamiliar people were present. Pedigree status, neuter status, a history of early trauma, sensitivity to being stroked, the absence of other cats in the home, relationship with other animals, level of background activity at home, access to the outside and tendency to be alone (meaning tendency to staying far from the family members) were all associated with an increased risk in one or more context. However, sex, age, age when acquired, source of pet, attachment to a specific household member, type of domestic accommodation, relationship with another cat if present and contact with other animals did not appear to increase the risk. The results suggest sensitivity to being stroked and background levels of stress in the home are the most pervasive risk factors, and future research should aim to investigate these factors further. These data are of relevance when advising owners about the risk and development of this problem.

scholarly journals Faktor Risiko Tuberkulosis pada Anak

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Muhammad S. D. Wijaya ◽  
Max F. J. Mantik ◽  
Novie H. Rampengan
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Case Report ◽  
Literature Review ◽  
Cigarette Smoke ◽  
Meta Analysis ◽  
Case Control ◽  
Google Scholar ◽  
Cross Sectional ◽  
History Of

Abstract: Tuberculosis (TB) is still one of the biggest health problems worldwide due to high morbidity and mortality rates. Moreover, Indonesia has the third largest TB cases in the world after India and China. This study was aimed to evaluate the risk factors of TB in children. This was a literature review study using three databases, namely Google Scholar, ClinicalKey, and PubMed. The results showed that after being selected by inclusion and exclusion criteria, there were 10 literatures in this study consisting of 2 case control studies, 4 cross sectional studies, 1 difference test, 1 meta-analysis, 1 case report, and 1 cohort study. The 10 literatures reviewed factors or characteristics of age, sex, history of BCG immunization, malnutrition, history of contact with person suffering from TB, exposure to cigarette smoke, occupant density, and poverty. Risk factors obtained from the review were young age (0-5 years), male sex, malnutrition, history of contact, and poverty. The other risk factors specifically history of BCG immunization, exposure to cigarette smoke, and occupant density were still contradicting among literatures. In conclusion, the most dominant risk factor of TB in children is history of contact with person suffering from TB. Keywords: risk factors, tuberculosis, children.  Abstrak: Penyakit tuberkulosis (TB) masih menjadi salah satu masalah kesehatan terbesar di dunia dikarenakan angka morbiditas dan mortalitas yang tinggi. selain itu Indonesia merupakan negara dengan kasus TB terbesar ketiga di dunia setelah India dan Tiongkok. Penelitian ini bertujuan untuk mengevaluasi faktor risiko tuberkulosis pada anak. Jenis penelitian ialah literature review dengan menggunakan tiga database, yakni Google Scholar, ClinicalKey, dan PubMed. Hasil penelitian mendapatkan bahwa diseleksi dengan kriteria inklusi dan eksklusi, didapatkan 10 literatur yang terdiri dari 2 case control study, 4 cross sectional study, 1 uji beda, 1 meta-analysis, 1 case report, dan 1 cohort study. Sepuluh literatur ini mengulas tentang pengaruh faktor atau karakteristik terhadap TB ada anak, yaitu: usia, jenis kelamin, riwayat imunisasi BCG, malnutrisi, riwayat kontak dengan pengidap TB, asap rokok, kepadatan hunian, dan kemiskinan. Faktor-faktor risiko yang diperoleh ialah usia muda (0-5 tahun), jenis kelamin laki-laki, malnutrisi, riwayat kontak, dan kemiskinan dapat memengaruhi kejadian TB pada anak. Faktor-faktor risiko lainnya yakni riwayat imunisasi BCG, paparan asap rokok, dan kepadatan hunian masih kontradiktif antar literatur. Simpulan penelitian ini ialah faktor risiko yang paling dominan menyebabkan penyakit TB pada anak ialah riwayat kontak.Kata kunci: faktor risiko, tuberculosis pada anak

scholarly journals Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies

2021 ◽  
Vol 14 ◽  
pp. 117954412110287
Author(s):  
Mir Sohail Fazeli ◽  
Vadim Khaychuk ◽  
Keith Wittstock ◽  
Boris Breznen ◽  
Grace Crocket ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Literature Review ◽  
Rheumatoid Factor ◽  
Qualitative Evidence Synthesis ◽  
Cvd Risk ◽  
Rheumatoid Arthritis Risk ◽  
Published Evidence ◽  
Increased Risk

Objective: To scope the current published evidence on cardiovascular risk factors in rheumatoid arthritis (RA) focusing on the role of autoantibodies and the effect of antirheumatic agents. Methods: Two reviews were conducted in parallel: A targeted literature review (TLR) describing the risk factors associated with cardiovascular disease (CVD) in RA patients; and a systematic literature review (SLR) identifying and characterizing the association between autoantibody status and CVD risk in RA. A narrative synthesis of the evidence was carried out. Results: A total of 69 publications (49 in the TLR and 20 in the SLR) were included in the qualitative evidence synthesis. The most prevalent topic related to CVD risks in RA was inflammation as a shared mechanism behind both RA morbidity and atherosclerotic processes. Published evidence indicated that most of RA patients already had significant CV pathologies at the time of diagnosis, suggesting subclinical CVD may be developing before patients become symptomatic. Four types of autoantibodies (rheumatoid factor, anti-citrullinated peptide antibodies, anti-phospholipid autoantibodies, anti-lipoprotein autoantibodies) showed increased risk of specific cardiovascular events, such as higher risk of cardiovascular death in rheumatoid factor positive patients and higher risk of thrombosis in anti-phospholipid autoantibody positive patients. Conclusion: Autoantibodies appear to increase CVD risk; however, the magnitude of the increase and the types of CVD outcomes affected are still unclear. Prospective studies with larger populations are required to further understand and quantify the association, including the causal pathway, between specific risk factors and CVD outcomes in RA patients.

scholarly journals Patients with SLE have higher risk of cardiovascular events and mortality in comparison with controls with the same levels of traditional risk factors and intima-media measures, which is related to accumulated disease damage and antiphospholipid syndrome: a case–control study over 10 years

2021 ◽  
Vol 8 (1) ◽  
pp. e000454
Author(s):  
Sofia Ajeganova ◽  
Ingiäld Hafström ◽  
Johan Frostegård
Keyword(s):  
Risk Factors ◽  
Antiphospholipid Syndrome ◽  
Carotid Plaque ◽  
Adverse Outcome ◽  
Density Lipoprotein ◽  
Index Score ◽  
Baseline Body Mass Index ◽  
Systemic Lupus ◽  
Increased Risk ◽  
History Of

ObjectiveSLE is a strong risk factor for premature cardiovascular (CV) disease and mortality. We investigated which factors could explain poor prognosis in SLE compared with controls.MethodsPatients with SLE and population controls without history of clinical CV events who performed carotid ultrasound examination were recruited for this study. The outcome was incident CV event and death. Event-free survival rates were compared using Kaplan-Meier curves. Relative HR (95% CI) was used to estimate risk of outcome.ResultsPatients (n=99, 87% female), aged 47 (13) years and with a disease duration of 12 (9) years, had mild disease at inclusion, Systemic Lupus Erythematosus Diseases Activity Index score of 3 (1–6) and Systemic Lupus International Collaborating Clinics (SLICC) Damage Index score of 0 (0–1). The controls (n=109, 91% female) were 49 (12) years old. Baseline carotid intima-media thickness (cIMT) did not differ between the groups, but plaques were more prevalent in patients (p=0.068). During 10.1 (9.8-10.2) years, 12 patients and 4 controls reached the outcome (p=0.022). Compared with the controls, the risk of the adverse outcome in patients increased threefold to fourfold taking into account age, gender, history of smoking and diabetes, family history of CV, baseline body mass index, waist circumference, C reactive protein, total cholesterol, high-density lipoprotein, low-density lipoprotein, dyslipidaemia, cIMT and presence of carotid plaque. In patients, higher SLICC score and SLE-antiphospholipid syndrome (SLE-APS) were associated with increased risk of the adverse outcome, with respective HRs of 1.66 (95% CI 1.20 to 2.28) and 9.08 (95% CI 2.71 to 30.5), as was cIMT with an HR of 1.006 (95% CI 1.002 to 1.01). The combination of SLICC and SLE-APS with cIMT significantly improved prediction of the adverse outcome (p<0.001).ConclusionIn patients with mild SLE of more than 10 years duration, there is a threefold to fourfold increased risk of CV events and death compared with persons who do not have SLE with similar pattern of traditional CV risk factors, cIMT and presence of carotid plaque. SLICC, SLE-APS and subclinical atherosclerosis may indicate a group at risk of worse outcome in SLE.

Phanerozoic trends in the global geographic disparity of marine biotas

Paleobiology ◽  
2009 ◽  
Vol 35 (4) ◽  
pp. 612-630 ◽  
Author(s):  
Arnold I. Miller ◽  
Devin P. Buick ◽  
Katherine V. Bulinski ◽  
Chad A. Ferguson ◽  
Austin J. W. Hendy ◽  
...  
Keyword(s):  
Geographic Distance ◽  
Marine Biodiversity ◽  
Marine Animal ◽  
Animal Life ◽  
Data Repositories ◽  
Geographic Disparity ◽  
The Family ◽  
Family Level ◽  
History Of

Previous analyses of the history of Phanerozoic marine biodiversity suggested that the post-Paleozoic increase observed at the family level and below was caused, in part, by an increase in global provinciality associated with the breakup of Pangea. Efforts to characterize the Phanerozoic history of provinciality, however, have been compromised by interval-to-interval variations in the methods and standards used by researchers to calibrate the number of provinces. With the development of comprehensive, occurrence-based data repositories such as the Paleobiology Database (PaleoDB), it is now possible to analyze directly the degree of global compositional disparity as a function of geographic distance (geo-disparity) and changes thereof throughout the history of marine animal life. Here, we present a protocol for assessing the Phanerozoic history of geo-disparity, and we apply it to stratigraphic bins arrayed throughout the Phanerozoic for which data were accessed from the PaleoDB. Our analyses provide no indication of a secular Phanerozoic increase in geo-disparity. Furthermore, fundamental characteristics of geo-disparity may have changed from era to era in concert with changes to marine venues, although these patterns will require further scrutiny in future investigations.

Abstract 27: Statin use and risk of hemorrhagic stroke in a community-based cohort of aging women: The Women’s Health Initiative

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Elena Salmoirago-Blotcher ◽  
Kathleen M Hovey ◽  
Judith K Ockene ◽  
Chris A Andrews ◽  
Jennifer Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Women's Health ◽  
Hemorrhagic Stroke ◽  
Extension Study ◽  
Prior History ◽  
Health Initiative ◽  
Increased Risk ◽  
History Of ◽  
Statin Use ◽  
The Women’S Health Initiative

Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with increased risk of hemorrhagic stroke among women enrolled in the Women’s Health Initiative (WHI). Methods: This secondary data analysis was conducted among 68,132 women enrolled in the WHI Clinical Trials (CTs). Participants were 50 to 79 yrs old; postmenopausal; and were followed through 2005 (parent study) and for an additional 5 yrs (through September 30, 2010) in the WHI extension study. Statin use was assessed at baseline and at follow-up (FU) visits at 1, 3, 6, and 9 years. Women brought all medications in original containers for inventory. Strokes were self-reported annually and adjudicated by medical record review. Risk of hemorrhagic stroke by statin use (modeled as a time-varying covariate, with the “no use” category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for hemorrhagic stroke (model 2); and possible confounders by indication (model 3). All models adjusted for enrollment in the different CTs and in the extension study. Participants were censored at the date of last contact or loss to FU. Pre-specified subgroup analyses were conducted according to use or non-use of antiplatelet medications (including aspirin) or anticoagulants, and prior history of stroke. Results: Final models included 67,882 women (mean age at baseline 63 ± 7 yrs). Over a mean FU of 12 yrs, incidence rates of hemorrhagic stroke were 6.4/10,000 person-years among women on statins and 5.0/10,000 person-years among women not taking statins. The unadjusted risk of hemorrhagic stroke in statin users vs. non-users was 1.21 (CI: 0.96, 1.53). The HR was attenuated to 0.98 (CI: 0.76, 1.26) after adjusting for age, hypertension, and other risk factors for hemorrhagic stroke. Planned subgroups analyses showed that women taking both statins and antiplatelet agents had a higher risk of hemorrhagic stroke than women taking antiplatelet medications without statins (HR: 1.59; CI: 1.02, 2.46), whereas women not taking antiplatelet medications had no risk elevation with statins (HR=0.79; CI: 0.58-1.08); P for interaction = .01. No significant interactions were found for anticoagulant use or prior history of stroke, but the statistical power for these analyses was low. Conclusion: Statin use was not associated with an overall increased risk of hemorrhagic stroke among older community-dwelling women. However, women taking statins in conjunction with antiplatelet medications had elevated risk; a finding that warrants further study and potential incorporation into clinical decision making.

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