Effect Of Fetal Exposure To Famine On Risk Of Stroke In Midlife

Objectives To investigate the effect of fetal exposure to the Great Chinese Famine1959～1961 on risk of stroke in midlife.Methods The participants were selected form the subjects of Kailuan study cohort who took part in the physical examination from 2006 to 2007.We selected 22802 participants who were born between October 1,1956 and September 30,1964,and excluded 4767 participants who were born between October 1,1958 and September 30,1959 or between October 1,1961 and September 30,1962.In addition,we further excluded 248 participants with a history of stroke,myocardial infarction,atrial fibrillation,or cancer prior to 2006,leaving 17787 participants for analysis.All participants were divided into three groups according to the birth date: unexposed group(born between October 1,1962 to September30,1964),fetal famine-exposed group(born between October 1,1959 to September 30,1961),early-childhood famine-exposed group(born between October 1,1956 to September30,1958).In this study,the date of physical examination from 2006 to 2007 was taken as the starting point of follow-up,the first occurrence of stroke as the outcome,and the end date of follow-up was December 31,2019.Cox proportional hazards regression was used to investigate the effect of fetal exposure to famine on risk of stroke,further analyses were performed on participants stratified by sex,overweight or obesity,salt intake and physical activity status.In addition,we conducted a sensitivity analysis by excluding the participants who used antihypertensive,hypoglycemic or lipid-lowering medication.Results During the mean(12.50±1.87)years of follow-up,840 incident stroke cases were identified.After adjusting for confounding factors,compared with the control group(unexposed group),the hazard ratio(HR)and 95% confidence interval(CI)for stroke was1.29(1.06～1.56)for the fetal famine-exposed group,and 1.32(1.13～1.55)for the earlychildhood famine-exposed group.After dividing stroke into ischemic stroke and hemorrhagic stroke,we found that fetal exposure to famine was only associated with the risk of ischemic stroke(HR=1.30,95%CI: 1.06～1.61),but not with hemorrhagic stroke.After stratification by sex,overweight or obesity,salt intake and physical activity status,the associations between fetal exposure to famine and stroke risk were only found in men(HR=1.26,95%CI: 1.02～1.55),inactive physical exercisers(HR=1.26,95%CI: 1.03～1.53),those with high salt intake(HR=1.26,95%CI: 1.03～1.54)and those with overweight or obesity(HR=1.31,95%CI: 1.05～1.64).Similar results were found in the stratified analysis of ischemic stroke.Conclusions Fetal exposure to famine was associated with the higher risk of stroke in midlife,particularly in men,inactive physical exercisers,those with high salt intake and those with overweight or obesity.Figure 0;Table 13;Reference 140...