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CHAGAS DISEASE PREDICTS 10-YEAR STROKE MORTALITY IN COMMUNITY-DWELLING ELDERLY THE BAMBUÍ COHORT STUDY OF AGING
Stroke mortality
Epidemiology
Etiology
Chagas disease
Trypanosoma Cruzi
Afiliación
Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil / Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brasil.
Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil / Universidade Federal de Minas Gerais. Hospital das Clínicas. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Belo Horizonte, MG, Brasil.
Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil / Universidade Federal de Minas Gerais. Hospital das Clínicas. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Hospital das Clínicas. Belo Horizonte, MG, Brasil.
Resumen en ingles
Background and Purpose—Previous case– control studies have suggested a causal link between Chagas disease, which is caused by the protozoan Trypanosoma cruzi, and stroke. We investigated the relationship between Chagas disease and long-term stroke mortality in a large community-based cohort of older adults.
Methods—Participants were 1398 (80.3% from total) residents aged _60 years in Bambuí City, Brazil. The end point was death from stroke. Potential confounding variables included age, sex, conventional stroke risk factors, and high sensitive C-reactive protein.
Results—Participants of this study were followed from 1997 to 2007 leading to 9740 person-years of observation. The baseline prevalence of T. cruzi infection was 37.5% and the overall mortality rate from stroke was 4.62 per 1000 person-years. The risk of death from stroke among T. cruzi-infected participants was twice that of those noninfected (adjusted hazard ratio, 2.36; 95% CI, 1.25 to 4.44). A B-type natriuretic peptide level in the top quartile was a strong and independent predictor of stroke mortality among those infected (adjusted hazard ratio, 2.72; 95% CI, 1.25 to 5.91). The presence of both a high B-type natriuretic peptide level and electrocardiographic atrial fibrillation increased the risk of stroke mortality by 11.49 (95% CI, 3.19 to 41.38) in these individuals.
Conclusions—This study provides new evidence supporting a causal link between Chagas disease and stroke. The results also showed that B-type natriuretic peptide alone or in association with atrial fibrillation has prognostic value for stroke mortality in T. cruzi chronically infected older adults
Palabras clave en ingles
Brain natriuretic peptideStroke mortality
Epidemiology
Etiology
Chagas disease
Trypanosoma Cruzi
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