Abstract 2562: Neighborhood Poverty, Personal Income and Incident Stroke in Black and White Participants in the REGARDS Study

Virginia J Howard; Abraham J Letter; Leslie A McClure; George Howard; Solveig Cunningham; Dawn O Kleindorfer; Amanda G Thrift; Ana V Diez Rouz

doi:10.1161/str.43.suppl_1.a2562

Abstract 2562: Neighborhood Poverty, Personal Income and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽

10.1161/str.43.suppl_1.a2562 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Virginia J Howard ◽

Abraham J Letter ◽

Leslie A McClure ◽

George Howard ◽

Solveig Cunningham ◽

...

Keyword(s):

Risk Factors ◽

Census Tract ◽

Stroke Risk ◽

Personal Income ◽

Poverty Level ◽

Neighborhood Poverty ◽

Black And White ◽

Stroke Risk Factors ◽

Income Neighborhood ◽

Regards Study

Background. Neighborhood poverty has been identified as an important risk factor for coronary heart disease, with an association that is independent of individual income. Associations of poverty with stroke outcomes have been mixed, and not all studies have included adjustment for risk factors. Methods. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,239 black and white adults > 45 years, enrolled 2003-2007. Baseline data collection included a centralized telephone interview for demographics and medical history and an in-home evaluation for physical measures. Participants are subsequently telephoned bi-annually for self- or proxy-reported stroke; then medical records are retrieved and adjudicated by physicians. Baseline home addresses were geocoded and linked to census tract, and percentage of census tract living below federal poverty level was determined from the 2000 US Census. Neighborhoods were stratified as wealthier (poverty levels below 15%) and poorer (15% and above). Participants reporting a physician-diagnosed stroke at baseline, missing income, < 80% reliability on geocoding, or no follow-up were excluded, leaving n=20,596. These participants resided across 10,471 census tracts. Proportional hazard models were fit to establish the association of incident stroke with neighborhood poverty within strata of personal income by race, adjusting for age, sex, and region (Stroke Belt, Buckle, or other) and further adjustment for education and Framingham stroke risk factors. Results. There were 460 strokes in the analysis cohort of 8,637 blacks and 11,959 whites; mean age was 64.5 years; 54% were women. After controlling for age, sex, region, and personal income, neighborhood poverty was not associated with increased stroke risk. However, there was a trend for blacks with low incomes and whites with high incomes to have increased risk if they lived in a poor neighborhood (see figure ). Further adjustment for education and stroke risk factors did not substantially alter results. Conclusions. We observed that within most levels of personal income, neighborhood poverty was not associated with stroke risk; however, there was an intriguing suggestion that residence in poor neighborhoods increases the risk for low income blacks and high income whites. Additional work using other measures of neighborhood socioeconomic status may be warranted.

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AGE-RELATED DIFFERENCES IN STROKE RISK FACTORS: INSIGHTS FROM THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY

10.26226/morressier.58e389afd462b80292384b6c ◽

2017 ◽

Author(s):

George Howard

Keyword(s):

Risk Factors ◽

Racial Differences ◽

Stroke Risk ◽

Stroke Risk Factors ◽

Age Related ◽

Regards Study

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Abstract WMP54: ABO Blood Type and Incident Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Stroke ◽

10.1161/str.44.suppl_1.awmp54 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Neil A Zakai ◽

Suzanne E Judd ◽

Leslie A McClure ◽

Brett M Kissela ◽

George Howard ◽

...

Keyword(s):

Risk Factors ◽

Racial Differences ◽

Stroke Risk ◽

Blood Type ◽

Stroke Risk Factors ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Regards Study ◽

Type Ab ◽

Von Willebrand

Background: Non-O blood type is associated with higher procoagulant proteins and potentially stroke. Prior studies may overestimate the association due to lack of control for race and stroke risk factors as there are known racial differences in blood type, conventional stroke risk factors, and stroke risk. Methods: REGARDS recruited 30,239 participants in their homes between 2003-07 from the continental US; 55% were female, 41% were black, and 56% lived in the southeast (by design). Using a case-cohort design, 553 participants with incident stroke and 991 participants without baseline stroke were genotyped to determine blood type. Cox proportional hazard models adjusting for race and Framingham or ARIC stroke risk factors were used to determine the association of blood type with incident stroke. Results: Blacks had a higher frequency of blood type B (17% vs. 10%) and AB (5% vs. 2%) and a lower frequency of blood type O (31% vs. 42%) than whites (p <0.001) (Table). Except for diabetes (OR 4.1 95% CI 2.1, 7.9) and higher systolic blood pressure (7.5 mm hg higher, p = 0.01) for blood type AB vs. O, stroke risk factors did not differ by blood type. Over 4.5 years of follow-up, neither blood types A or B were associated with incident stroke accounting for race and traditional stroke risk factors (Table). Blood type AB was associated with a marginally increased risk of stroke after adjusting for race and Framingham (HR 1.8; 95% CI 1.0, 3.4) or ARIC (HR 1.8; 95% CI 1.0, 3.3) stroke risk factors (Table). Discussion: Blood type AB is associated with an increased risk of stroke which is not mediated by conventional stroke risk factors. This association could relate to increased factor VIII or von Willebrand factor in individuals with non-O blood type but this does not explain the unique association of blood type AB with stroke. Whether blood type should be incorporated into clinical stroke risk models is unknown.

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Pro-neurotensin/neuromedin N and risk of ischemic stroke: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Vascular Medicine ◽

10.1177/1358863x20957406 ◽

2020 ◽

Vol 25 (6) ◽

pp. 534-540

Author(s):

Charles D Nicoli ◽

Nicholas Wettersten ◽

Suzanne E Judd ◽

George Howard ◽

Virginia J Howard ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Ischemic Stroke ◽

Racial Differences ◽

Stroke Risk ◽

Cox Proportional Hazards Model ◽

Demographic Model ◽

Stroke Risk Factors ◽

Regards Study ◽

Neuromedin N

The tridecapeptide neurotensin has been implicated in the pathogenesis of cardiometabolic disease. Its stable precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), has been associated with composite cardiovascular outcomes including coronary heart disease (CHD) and stroke. The exclusive association of pro-NT/NMN with ischemic stroke has not been evaluated. We conducted a prospective case-cohort study in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. From 2003 to 2007, REGARDS enrolled 30,239 white or black adults aged ⩾ 45 years. Baseline fasting pro-NT/NMN was measured by immunoassay in the analytic sample including 448 incident ischemic stroke cases and 818 random cohort sample participants. A total of 464 ischemic strokes occurred. Risk of stroke was assessed with a Cox proportional-hazards model incorporating demographic covariates and a second adding stroke risk factors. Increased pro-NT/NMN was associated with ischemic stroke in the demographic model overall (hazard ratio (HR) per standard deviation (SD) pro-NT/NMN 1.16, 95% confidence interval (CI) 1.01–1.33) and in men (HR per SD pro-NT/NMN 1.25, 95% CI 1.04–1.50); HRs were attenuated in the risk factor model. Pre-existing diabetes mellitus and CHD were the largest confounders of ischemic stroke risk, each accounting for an estimated 19% of the association of pro-NT/NMN with ischemic stroke observed in the demographic model. There were no significant interactions of race or sex with pro-NT/NMN. Further research on associations of pro-NT/NMN with stroke risk factors such as diabetes mellitus is indicated.

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Abstract MP88: Dehydroepiandrosterone (DHEAS) and Risk of Stroke in Black and White Americans: The Reasons for Geographic and Racial Differences in Stroke Cohort (REGARDS)

Circulation ◽

10.1161/circ.131.suppl_1.mp88 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Markus Degirmenci ◽

Peter W Callas ◽

Suzanne E Judd ◽

Virginia Howard ◽

Nancy S Jenny ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Racial Differences ◽

Stroke Risk ◽

Inverse Association ◽

Baseline Serum ◽

Men And Women ◽

Black And White ◽

Stroke Risk Factors ◽

Increased Risk

Introduction: The association of DHEAS with coronary risk has been extensively studied, but little information is available on stroke risk. DHEAS levels are lower with stroke risk factors such as atrial fibrillation, arterial stiffness and atherosclerosis, but only one paper evaluated stroke risk and showed an inverse association of DHEAS and stroke risk in female nurses. Hypothesis: We assessed the hypothesis that lower DHEAS level is associated with increased ischemic stroke risk. Methods: REGARDS enrolled 30,239 US participants aged 45 and older in 2003-07 (41% black, 59% white, 55% living in the southeastern stroke belt). Baseline serum DHEAS was measured in 1,578 participants; 963 in a cohort random sample and 544 with first-time ischemic stroke during 5.4 years of follow up. Cox proportional hazard models with weights to account for the case cohort design were used to calculate hazard ratios (HR) of stroke by quartiles of DHEAS levels. Results: DHEAS was significantly lower with older age, white race, female sex, and history of heart disease. DHEAS in the first compared to the fourth quartile was associated with increased risk of stroke (HR 1.7, CI: 1.2-2.4), although this association was not present after adjusting for age (or other stroke risk factors: HR 1.0, CI: 0.7-1.6). These findings were similar in men and women. Stratifying on age, as shown in the table, in those <65 at baseline, lower DHEAS was associated with increased stroke after adjustment for sex, race, and Framingham stroke risk factors (HR 3.1, CI: 1.3-7.6), but there was no association in those >65 years (HR 0.8, CI: 0.5-1.4). Conclusion: There was no overall association of lower DHEAS and stroke risk in this bi-racial cohort of men and women from across the US, although a possible difference by age was observed. More research is needed to determine association of DHEAS with stroke risk.

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Abstract P351: Inflammation and Stroke Risk in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.129.suppl_1.p351 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Nancy S Jenny ◽

Peter Callas ◽

Neil A Zakai ◽

Leslie McClure ◽

Suzanne Judd ◽

...

Keyword(s):

Risk Factors ◽

Racial Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Stroke Patients ◽

Stroke Risk Factors ◽

Cox Proportional Hazards Models ◽

Regards Study

Background: Levels of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 and the anti-inflammatory cytokine IL-10 are altered in acute stroke patients compared to controls. However, results for IL-10 are inconsistent (higher in stroke patients compared to controls in some studies and decreased in others) and very few studies have examined associations of these biomarkers with risk of incident stroke. Methods: We examined associations of baseline levels of IL-6, IL-8 and IL-10 with stroke risk factors and risk of incident stroke in 1,572 white and black men and women from the REGARDS Study; an observational cohort of 30,239 adults followed for 5 years. Among those without prebaseline stroke, stroke cases (n=592, 53% men, 59% white, mean age 70 years) were compared to a cohort random sample (n=980, 44% men, 58% white, mean age 65 years). We used Cox proportional hazards models to examine associations of biomarkers with incident stroke. Hazard ratios (HR; 95% confidence intervals) for highest compared to lowest quartile for each biomarker are presented. Results: Baseline IL-6 was significantly higher in incident stroke cases compared to the cohort sample (p<0.001) while IL-8 and IL-10 levels did not vary significantly (p>0.05 for both). Adjusting for age, sex and race, IL-6 was higher in blacks compared to whites and higher in current smokers compared to never/former smokers (all p≤0.01). IL-6 was inversely associated with physical activity, alcohol use and education (all p≤0.01). IL-8 and IL-10 did not vary significantly with the risk factors examined. Adjusting for age, sex and race, the HR for risk of incident stroke in those in the highest compared to lowest quartile of IL-6 was 2.4 (1.6-3.4). HRs for IL-8 and IL-10 were 1.5 (1.0-2.1) and 1.4 (1.0-1.9), respectively. Adjusting for Framingham stroke risk factors and history of coronary heart disease, only IL-6 remained significantly associated with stroke risk (HR 2.0; 1.3-3.2). HRs for IL-8 and IL-10 were 1.1 (0.7-1.6) and 1.2 (0.8-1.8), respectively. IL-6 remained significantly associated with stroke risk when C-reactive protein was added to the model (HR 1.7; 1.1-2.7). Associations did not differ by race. Conclusions: In this population-based sample of US black and white adults, IL-6, but not IL-8 or IL-10, was associated with stroke risk factors and risk of incident stroke. Further study is needed on the clinical utility of IL-6 measurement in stroke risk assessment.

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Abstract WP214: Differential Impact of Stroke Risk Factors Across the Age Spectrum: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Stroke ◽

10.1161/str.50.suppl_1.wp214 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

Dawn O Kleindorfer ◽

...

Keyword(s):

Risk Factors ◽

Racial Differences ◽

Stroke Risk ◽

Differential Impact ◽

Stroke Risk Factors ◽

Regards Study

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Abstract W MP64: Incident Stroke and Alcohol Consumption among Older Adults

Stroke ◽

10.1161/str.46.suppl_1.wmp64 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Solveig A Cunningham ◽

Aleena Mosher ◽

Suzanne E Judd ◽

Lisa M Matz ◽

Edmond K Kabagambe ◽

...

Keyword(s):

Alcohol Consumption ◽

Racial Differences ◽

Medical Records ◽

Stroke Risk ◽

Proportional Hazard ◽

Black And White ◽

Stroke Risk Factors ◽

Regards Study ◽

White Adults

Background: Alcohol consumption may reduce the risk of stroke. While both stroke and alcohol consumption patterns differ by race and sex, it is not known to what extent alcohol consumption contributes to the elevated risk of stroke in some groups, particularly in men and blacks in general. Methods: Risk of stroke was studied in 25,162 black and white adults aged 45+, in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Information on alcohol consumption was obtained by telephone interview at baseline. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke; medical records are retrieved and adjudicated by physicians Proportional hazard models, adjusted for demographic, socioeconomic, and stroke risk factors , were used. Results: Participants’ mean age was 64.7 years; 40% were black and 56% were women with 867 stroke events and a median follow-up time of 7.6 years. Compared to current drinkers, non-drinkers had 36% higher hazards of incident stroke which was significantly higher consistent across all race-sex groups except black men. Risks were particularly high among past drinkers (50% higher than among current drinkers), as would be expected since many may have stopped drinking due to health problems. However, risks were also elevated among lifetime abstainers. Differences in stroke risks were explained by demographic and socioeconomic differences between drinkers and non-drinkers. Among those who are current drinkers, those who consumed <1 drink per week had significantly lower hazards of stroke than moderate drinkers, and these protective factors remained marginally significant after accounting for demographic, socioeconomic, behavioral and health characteristics. Conclusions: Results suggest that individuals who do not currently consume alcohol may experience higher risks of stroke, which may be due in part due to socio-demographic and other characteristics associated with consuming alcohol.

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