Abstract P406: Atrial Fibrillation (AF) and Stroke Symptoms in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Meghan Reading Turchioe ◽  
Elsayed Z Soliman ◽  
Hooman Kamel ◽  
Mary Cushman ◽  
Orysya Soroka ◽  
...  
Keyword(s):  
Racial Differences ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Embolic Stroke ◽  
Cumulative Number ◽  
Logistic Regression Models ◽  
Stroke Symptom ◽  
Stroke Diagnosis ◽  
Regards Study ◽  
Ischemic Attack

Background: AF-related thromboembolism increases risk of stroke. Stroke symptoms in the absence of a stroke diagnosis may represent “whispering strokes,” but their association with AF has not been well explored. Objective: To examine cross-sectionally the association between AF and self-reported stroke symptoms in the absence of a stroke diagnosis, and whether associations differ by anticoagulant use. Methods: We examined data from 27,072 REGARDS participants without a history of stroke or transient ischemic attack (TIA) at baseline. The presence, type, and cumulative number of self-reported stroke symptoms were compared between participants with and without self-reported history or ECG evidence of AF. Logistic regression models examined associations between AF and stroke symptoms, adjusting for sociodemographic, socioeconomic, stroke risk factors, and geographic characteristics. To investigate the possibility of stroke symptoms representing embolic stroke, results were stratified by anticoagulant or antiplatelet agent use. Results: The mean age of the sample was 64.4(±9.4), 55.3% were women, and 59.2% were black; 2,124 had evidence of AF. Twenty-nine percent of adults with AF and 17% of those without AF reported at least one stroke symptom. Compared to those without AF, the odds ratio (OR) of any stroke symptom was 2.21 (95% CI 1.88-2.58) among adults with AF not using an anticoagulant or antiplatelet agent and 1.93 (95% CI 1.62-2.30) for those on Aspirin or Plavix only ( Table 1 ). Associations were non-significant for those using Warfarin. Similar patterns were observed by each type and cumulative number of stroke symptoms. Conclusion: The association between AF and stroke symptoms suggests that some stroke symptoms in the absence of a stroke diagnosis may represent sub-clinical or “whispering strokes.” The attenuation of this association with Warfarin use but not antiplatelet agents supports the possibility that stroke symptoms in the absence of a stroke diagnosis represent undiagnosed embolic stroke.

scholarly journals Atrial Fibrillation and Stroke Symptoms in the REGARDS Study

2022 ◽  
Author(s):  
Meghan Reading Turchioe ◽  
Elsayed Z. Soliman ◽  
Parag Goyal ◽  
Alexander E. Merkler ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Racial Differences ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Clinical History ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Stroke Diagnosis ◽  
Ischemic Attack

Background It is unknown if stroke symptoms in the absence of a stroke diagnosis are a sign of subtle cardioembolic phenomena. The objective of this study was to examine associations between atrial fibrillation (AF) and stroke symptoms among adults with no clinical history of stroke or transient ischemic attack (TIA). Methods and Results We evaluated associations between AF and self‐reported stroke symptoms in the national, prospective REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort. We conducted cross‐sectional (n=27 135) and longitudinal (n=21 932) analyses over 8 years of follow‐up of REGARDS participants without stroke/transient ischemic attack and stratified by anticoagulant or antiplatelet agent use. The mean age was 64.4 (SD±9.4) years, 55.3% were women, and 40.8% were Black participants; 28.6% of participants with AF reported stroke symptoms. In the cross‐sectional analysis, comparing participants with and without AF, the risk of stroke symptoms was elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (odds ratio [OR], 2.22; 95% CI, 1.89–2.59) or antiplatelet agents only (OR, 1.92; 95% CI, 1.61–2.29) but not for adults with AF taking anticoagulants (OR, 1.08; 95% CI, 0.71–1.65). In the longitudinal analysis, the risk of stroke symptoms was also elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (hazard ratio [HR], 1.41; 95% CI, 1.21–1.66) or antiplatelet agents only (HR, 1.23; 95% CI, 1.04–1.46) but not for adults with AF taking anticoagulants (HR, 0.86; 95% CI, 0.62–1.18). Conclusions Stroke symptoms in the absence of a stroke diagnosis may represent subclinical cardioembolic phenomena or “whispering strokes.” Future studies examining the benefit of stroke symptom screening may be warranted.

Abstract P281: Medication Adherence and Stroke/TIA Risk in Treated Hypertensives: Results from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Doyle M Cummings ◽  
Abraham J Letter ◽  
George Howard ◽  
Virginia J Howard ◽  
Monika Safford ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Racial Differences ◽  
Population Based ◽  
Hazard Ratio ◽  
Logistic Regression Models ◽  
Adherence Score ◽  
Increased Risk ◽  
Regards Study ◽  
Ischemic Attack ◽  
Perfect Adherence

Background: Low medication adherence in treated hypertensives is an important modifiable barrier to achieving blood pressure (BP) control. The contribution of poor medication adherence to adverse cardiovascular outcomes such as stroke and transient ischemic attack (TIA) relative to other cerebrovascular risk factors is less well understood. We therefore examined the relationship between medication adherence and both adequate BP control (< 140/90 mmHg) and stroke/TIA incidence in treated hypertensive subjects (n = 15,071 subjects free of stroke/TIA at baseline; 51% black; 57% living in the Stroke Belt) in REGARDS, a population-based cohort study. Methods: BP was measured in the subject’s home by a trained health professional following a standardized protocol. Medication adherence was measured at baseline (4-item validated Morisky scale: 0 = perfect adherence, 4 = lowest adherence). Participants were contacted bi-annually by telephone for a median follow-up time of 5 years and self-reported stroke or TIA events were adjudicated by medical record review. We used logistic regression models to examine the association between medication adherence and BP control and Cox modeling to evaluate the effect of adherence on stroke/TIA risk, examining the mediating effects of systolic BP. Results: Perfect medication adherence (score = 0) was reported by 69% of subjects, 23% a score of 1, 5% a score of 2, and 3% a score of 3 or 4. Mean systolic BP varied from 130.8 ± 16.2 in those reporting perfect adherence (Morisky score of 0) to 137.8 ± 19.5 in those reporting low medication adherence (score of 3 or 4) (p for trend< 0.0001). Compared to a Morisky score of 0, each level of worsening medication adherence was associated with significant and increasing odds of inadequately controlled BP (≥ 140/90 mmHg) in fully adjusted models: score = 1, odds ratio (95% CI) = 1.19 (1.09 – 1.30); score = 2, 1.27 (1.08–1.49); score = 3 or 4, 2.21 (1.75 – 2.78). Compared to perfect adherence, low medication adherence was not independently associated with stroke [hazard ratio = 1.04 (95% CI: 0.51 – 2.12)] or stroke and/or TIA [hazard ratio = 0.81 (95% CI: 0.38 – 1.73)] after multivariable adjustment. However, in analyses with systolic BP as the mediating variable, low medication adherence was associated with an increased risk for stroke (hazard ratio = 1.08 (95% CI: 1.04 – 1.14) and for stroke and/or TIA [hazard ratio = 1.08 (95% CI: 1.03 – 1.12)] in fully adjusted models. Conclusion: These findings add further evidence that low medication adherence is strongly associated with poor BP control; and through BP, low adherence is also associated with an increased risk of stroke or TIA.

Abstract WP482: Early Life Exposure to the Stroke Belt and Later Life Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Virginia J Howard ◽  
George Howard ◽  
Jennifer J Manly ◽  
M M Glymour ◽  
Laura B Zahodne ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Racial Differences ◽  
Early Adulthood ◽  
Later Life ◽  
Logistic Regression Models ◽  
Early Life Exposure ◽  
Increased Risk ◽  
Regards Study ◽  
Adjusted Logistic Regression ◽  
Stroke Belt

Introduction: Incidence of cognitive impairment is higher for residents of the Stroke Belt (SB) compared to those living outside it, but the importance of timing of SB residence is unclear. Methods: Participants were aged 45+ yrs, and enrolled in 2003-2007 in REGARDS. Cognition was assessed annually, by telephone, using the Six-Item Screener (SIS) in 11,488 black or white stroke-free participants currently living in the SB, and 8,949 currently living outside of the SB. Incident cognitive impairment was defined as SIS score of < 4 at last assessment among participants with initial SIS >4. Exposures were defined as SB residence all years, some years, or no years of childhood (ages 0-18) and early adulthood (ages 19-30). Demographic adjusted logistic regression models were stratified by SB residence at enrollment, and were used to estimate the demographic-adjusted odds of incident cognitive impairment. Results: Among those currently residing in the SB, childhood residence outside the SB for some (OR = 0.82; 95% CI: 0.68 - 0.99) or all (OR = 0.76; 95% CI: 0.65 - 0.90) of the time predicted lower odds of incident cognitive impairment. Similarly, early adulthood residence outside the SB for some (OR = 0.86; 95% CI: 0.74 - 0.98) or all (OR = 0.70; 95% CI: 0.58 - 0.84) of the time predicted lower incident cognitive impairment. Conversely, for those currently living outside the SB, the risk of incident cognitive impairment was higher for those who had spent their entire early adulthood in the SB (OR = 1.51; 95% CI: 1.01 - 2.57), with non-significant increased risk for childhood exposure or some early adulthood exposure to the SB (table). Conclusions: These findings suggest that early residence in the SB during childhood or early adulthood increases the risk of cognitive impairment regardless of place of residence in later adulthood. Further research is needed to determine the characteristics of early SB life that are linked to later adult cognitive impairment.

scholarly journals Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Stroke ◽  
2013 ◽  
Vol 44 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Suzanne E. Judd ◽  
Dawn O. Kleindorfer ◽  
Leslie A. McClure ◽  
J. David Rhodes ◽  
George Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Transient Ischemic Attack ◽  
Self Report ◽  
Regards Study ◽  
Ischemic Attack

scholarly journals Antiplatelet Therapy in the Secondary Prevention of Non-cardioembolic Ischemic Stroke and Transient Ischemic Attack: A Mini-Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Martin Vališ ◽  
Blanka Klímová ◽  
Michal Novotný ◽  
Roman Herzig
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
English Studies ◽  
Transient Ischemic Attacks ◽  
Severe Stroke ◽  
Neurological Outcomes ◽  
Ischemic Attack

The aim of this mini-review is to discuss the main antiplatelet agents that have been successfully used in the secondary prevention of non-cardioembolic ischemic stroke and transient ischemic attacks (TIA). The methodology is based on a literature review of available peer-reviewed English studies listed in PubMed. The findings reveal that aspirin remains a reliable antiplatelet agent in the secondary prevention of acute non-cardioembolic ischemic stroke and TIA. Nevertheless, currently, there are also other agents, i.e., ticagrelor, clopidogrel, and cilostazol, that can be applied. In addition, the results indicate that time is significant not only in severe stroke but also in non-severe stroke and TIA, which suggests that antiplatelet therapy should be applied within 24 h after the first symptoms because early treatment can lead to an improvement in neurological outcomes and reduce the chance of an early subsequent stroke.

Disparities in cognitive impairment with anticholinergic drug use: A population-based study

2020 ◽  
pp. 10.1212/CPJ.0000000000000952
Author(s):  
Md Motiur Rahman ◽  
George Howard ◽  
Jingjing Qian ◽  
Kimberly Garza ◽  
Ash Abebe ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Racial Differences ◽  
Urban Areas ◽  
Anticholinergic Drug ◽  
Population Based ◽  
Beers Criteria ◽  
Logistic Regression Models ◽  
Interaction Terms ◽  
Regards Study ◽  
Adjusted Model

Objectives:We aim to evaluate the association between anticholinergic drug (ACH) use and cognitive impairment and the effect of disparity parameters (sex, race, income, education, and rural or urban areas) on this relationship.Methods:The analyses included 13,623 adults aged ≥65 years from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study (recruited 2003-2007). The ACH use was defined by the 2015 Beers Criteria and cognitive impairment was measured by the Six-Item Cognitive Screener. Multivariable logistic regression models assessed disparities in cognitive impairment with ACH use, iteratively adjusting for disparity parameters and other covariates. The full models included interaction terms between ACH use and other covariates. A similar approach was used for class-specific ACH exposure and cognitive impairment analyses.Results:Approximately 14% of the participants used at least one ACH listed in the Beers criteria. Antidepressants were the most frequently prescribed ACH class. A significant sex-race interaction illustrated that females compared with males (in blacks: odds ratio [OR]=1.28, 95% CI 1.10–1.49 and in whites: OR=1.96, 95% CI 1.74–2.20), and especially white females (black vs. white: OR=0.71, 95% CI 0.64–0.80) were more likely to receive ACHs. Higher odds of cognitive impairment were observed among ACH users compared with the non-users (OR=1.26, 95% CI 1.01–1.58). In our class level analyses, only antidepressant users (OR=1.60, 95% CI 1.14–2.25) showed a significant association with cognitive impairment in the fully adjusted model.Conclusion:We observed demographic and socioeconomic differences in ACH use and in cognitive impairment, individually.

scholarly journals Lipid management among individuals with inflammatory arthritis in the national REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort

2017 ◽  
Vol 46 (1) ◽  
pp. 62-69
Author(s):  
Iris Navarro-Millán ◽  
Christopher M. Gamboa ◽  
Jeffrey R. Curtis ◽  
Monika M. Safford
Keyword(s):  
Risk Factor ◽  
Racial Differences ◽  
Inflammatory Arthritis ◽  
Cvd Risk ◽  
Lipid Management ◽  
Logistic Regression Models ◽  
Risk Optimization ◽  
Lipid Guidelines ◽  
National Cohort ◽  
Regards Study

Objective Hyperlipidemia guidelines do not currently identify inflammatory arthritis (IA) as a cardiovascular disease (CVD) risk factor. We compared hyperlipidemia treatment of individuals with and without IA (rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis) in a large national cohort. Methods Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were classified as having IA (without diabetes or hypertension); diabetes (but no IA); hypertension (but no diabetes or IA); or no IA, diabetes, or hypertension. Multivariable logistic regression models examined the odds of medical treatment among those with hyperlipidemia. Results Thirty-nine participants had IA, 5423 had diabetes, 7534 had hypertension, and 5288 had no diabetes, hypertension, or IA. The fully adjusted odds of treatment were similar between participants with IA and those without IA, hypertension, or diabetes. Participants with diabetes and no IA and participants with hypertension and no IA were twice as likely to be treated for hyperlipidemia as those without IA, diabetes, or hypertension. Conclusion Despite their higher CVD risk, patients with IA were as likely to be treated for hyperlipidemia as those without diabetes, hypertension, or IA. Lipid guidelines should identify IA as a CVD risk factor to improve CVD risk optimization in IA.

Pro-Neurotensin/Neuromedin N and Risk of Incident Metabolic Syndrome and Diabetes Mellitus in the REGARDS Cohort

2021 ◽  
Author(s):  
Charles D Nicoli ◽  
April P Carson ◽  
Timothy B Plante ◽  
D Leann Long ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Racial Differences ◽  
Regression Models ◽  
Logistic Regression Models ◽  
Low Hdl ◽  
Regards Study ◽  
Neuromedin N

Abstract Context The peptide neurotensin is implicated in insulin resistance, diabetes mellitus (DM), and cardiovascular disease. Objective We studied the association of neurotensin’s stable precursor, pro-neurotensin/neuromedin N (pro-NT/NMN) with incident metabolic syndrome (MetS) and DM. Design/Setting/Participants We included 3,772 participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who completed the baseline exam (2003-2007), the follow-up exam (2013-2016), and had pro-NT/NMN measured by immunoassay. Weighted logistic regression models were fitted to incident DM, incident MetS, and each MetS component, separately, incorporating demographics, metabolic risk factors, HOMA-IR, and diet scores. Main Outcome Measures Incident MetS was defined by ≥3 harmonized criteria at follow-up in those with &lt;3 at baseline. Incident DM was defined by use of hypoglycemic drugs/insulin, fasting glucose ≥126 mg/dL, or random glucose ≥200 mg/dL, in those without these at baseline. Results Median [IQR] plasma pro-NT/NMN was 160 [118-218] pmol/L. 564 (of 2,770 without baseline MetS) participants developed MetS and 407 (of 3,030 without baseline DM) developed DM. Per standard deviation (SD) higher log-Pro-NT/NMN, the demographic-adjusted odds ratio (OR) and 95% confidence interval (CI) of incident MetS was 1.22 (1.11-1.35); 1.16 (1.00-1.35) for incident low HDL, and 1.25 (1.11-1.40) for incident dysglycemia. The association of pro-NT/NMN with MetS was attenuated in the model adding HOMA-IR (OR per SD log-pro-NT/NMN 1.14, 95% CI 1.00-1.30). There was no association with incident DM (OR per SD log-pro-NT/NMN 1.06, 95% CI 0.94-1.19). Conclusions Pro-NT/NMN was associated with MetS and two components, dysglycemia and low HDL, likely explained by insulin resistance.

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