Abstract TMP48: Stroke Symptoms and Risk of Future Hospitalization: Implications for an Easy and Quick Screening for an Important Patient-Centered Outcome

Background: Stroke symptoms in the general population are common (≈18% of adults 45+) and are associated with future stroke. These symptoms may also identify a broad spectrum of clinically-undetected vascular conditions. Methods: Stroke symptoms (sudden weakness, numbness, unilateral or general loss of vision, and loss of ability to communicate or understand) and time to self-reported hospitalization for any cardiovascular (CVD) reason (heart, stroke, or TIA) or stroke were assessed in the REGARDS Study (a national, population-based, longitudinal study of 30,239 African-American and white adults > 45 years enrolled 2003-2007). The symptom-hospitalization association was assessed by proportional hazards analysis in persons stroke/TIA-free at baseline, with adjustment for demographics (age, race and sex), further adjustment for SES (income and education), CVD risk factors (smoking, hypertension, diabetes, dyslipidemia, atrial fibrillation and heart disease), and “perceived health status.” Results: Over an average follow-up of 5.6 years, presence of any stroke symptom was associated with greater risk of hospitalization for stroke (11% versus 6%; HR = 1.68; 95% CI: 1.52 - 1.85), a risk only modestly attenuated by adjustment for SES (HR = 1.59; 95% CI: 1.44 - 1.76), risk factors (HR = 1.44; 95% CI: 1.29 - 1.60), and perceived health (HR = 1.37; 95% CI: 1.23 - 1.53). However, presence of any stroke symptom was more strongly related to hospitalization for CVD (42% vs. 24%; HR = 1.92; 95 CI: 1.82 - 2.03), only modestly mediated by adjustment for SES (HR = 1.82; 95% CI: 1.73 - 1.93), risk factors (HR = 1.66; 95% CI: 1.57 - 1.76), and perceived health (HR = 1.57; 95% CI: 1.48 - 1.66). Conclusions: Stroke symptoms appear to be a marker not only for stroke risk, but also for general CVD. Simple questions can identify 18% of the general population that have over a 40% chance of hospitalization for CVD over a 5-year horizon. Implications for potential intervention to reduce risk are profound.

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Temporal trends in cardiovascular disease risk factor profiles in a population-based schizophrenia sample: a repeat cross-sectional study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-209565 ◽

2017 ◽

Vol 72 (1) ◽

pp. 71-77 ◽

Cited By ~ 2

Author(s):

Maria Chiu ◽

Farah Rahman ◽

Simone Vigod ◽

Andrew S Wilton ◽

Paul Kurdyak

Keyword(s):

Risk Factors ◽

Risk Factor ◽

General Population ◽

Temporal Trends ◽

Population Based ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Targeted Interventions ◽

Schizophrenia Group ◽

Obesity And Diabetes

BackgroundPeople with schizophrenia have an increased burden of cardiovascular diseases (CVD); however, little is known about the cardiovascular risk factor profiles of non-institutionalised individuals with schizophrenia. This study estimated the prevalence of CVD risk factors in a population-based sample of Canadians with and without schizophrenia.MethodsOntario respondents of the Canadian Community Health Survey were linked to administrative health databases; using a validated algorithm, we identified 1103 non-institutionalised individuals with schizophrenia and 156 376 without schizophrenia. We examined the prevalence of eight CVD risk factors: smoking, diabetes, hypertension, obesity, physical inactivity, fruit/vegetables consumption, psychosocial stress and binge drinking. To examine temporal trends, we compared prevalence estimates from 2001–2005 to 2007–2010.ResultsThe prevalence of most CVD risk factors was significantly higher among those with schizophrenia than the general population. Obesity and diabetes prevalence increased by 39% and 71%, respectively, in the schizophrenia group vs 11% and 24%, respectively, in the non-schizophrenia group between the two time periods. Unlike the general population, smoking rates among those with schizophrenia did not decline. Almost 90% of individuals with schizophrenia had at least one CVD risk factor and almost 40% had ≥3 co-occurring risk factors.ConclusionIndividuals with schizophrenia had a greater prevalence of individual and multiple CVD risk factors compared with those without schizophrenia, which persisted over time. Our findings suggest that public health efforts to reduce the burden of CVD risk factors have not been as effective in the schizophrenia population, thus highlighting the need for more targeted interventions and prevention strategies.

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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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Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

European Heart Journal ◽

10.1093/ehjci/ehaa946.2826 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.Q Wu ◽

X Li ◽

J.P Lu ◽

B.W Chen ◽

Y.C Li ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Population Based ◽

Staple Food ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Food Factor ◽

Rural And Urban ◽

Activity Factor

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p<0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p<0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

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Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽

10.1136/heartjnl-2021-319129 ◽

2021 ◽

pp. heartjnl-2021-319129

Author(s):

Marios Rossides ◽

Susanna Kullberg ◽

Johan Grunewald ◽

Anders Eklund ◽

Daniela Di Giuseppe ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

General Population ◽

Strong Predictor ◽

Strong Association ◽

International Classification Of Diseases ◽

Population Based ◽

Clinical Predictors ◽

Cox Models ◽

Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

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Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

Clinical Research in Cardiology ◽

10.1007/s00392-021-01907-x ◽

2021 ◽

Author(s):

Jan-Per Wenzel ◽

Ramona Bei der Kellen ◽

Christina Magnussen ◽

Stefan Blankenberg ◽

Benedikt Schrage ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

General Population ◽

Diastolic Dysfunction ◽

Cardiovascular Risk Factors ◽

Population Based ◽

Left Ventricular ◽

Health Study ◽

Common Finding

Abstract Aim Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. Methods and results From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. Conclusion The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

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Abstract P156: Assessing the Effect of the Heart of New Ulm Project: a Population-Based Program to Reduce Cardiovascular Disease

Circulation ◽

10.1161/circ.135.suppl_1.p156 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Abbey C Sidebottom ◽

Arthur Sillah ◽

David M Vock ◽

Michael M Miedema ◽

Raquel Pereira ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Health System ◽

Matched Control ◽

Population Based ◽

Control Population ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Matched Control Population

Background: Despite a highly recognized priority for public health and healthcare to implement population-level strategies to reduce the burden of cardiovascular disease (CVD), limited evidence exists on the most effective strategies. Data collection and evaluation of large scale, community based-prevention programs can be challenging and costly to achieve. The Heart of New Ulm (HONU) Project, begun in 2009, is a population-based initiative with healthcare, community, and workplace interventions addressing multiple levels of the social-ecological model designed to reduce modifiable CVD risk factors in rural New Ulm, MN. The community is served by one health system, enabling the use of electronic health record (EHR) data for surveillance. Objective: To assess trends for CVD risk factors, events, and healthcare utilization for New Ulm residents compared to a matched control population. Methods: We matched New Ulm residents (n = 4,077) with controls (n = 4,077) from a regional community served by the same health system using refined covariate balance techniques to match on baseline demographics, CVD risk factors, and health care utilization. Mixed effects longitudinal models with adjustment for age and gender, and an interaction for time by community, were run. Model based estimates were constructed for the entire cohort at each time period. Results: Over the first 6 years of the HONU Project,blood pressure, LDL, total cholesterol, and triglycerides were managed better in New Ulm than the matched comparison community. The proportion of New Ulm residents with controlled blood pressure increased by 6.2 percentage points while the control group increased by 2 points. 10-year ASCVD risk scores showed less decline for New Ulm residents than controls (16 vs. 18.4). The intervention and control groups did not differ with regard to inpatient stays, CVD events, smoking, or glucose. Conclusions: Compared to a matched control population, we found improved control of CVD risk factors in the New Ulm Population exposed to the HONU Project.

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Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap323 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Daniel L Halberg ◽

Charles Sands ◽

Paul Muntner ◽

Monika Safford

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Pulse Pressure ◽

Proportional Hazards ◽

Linear Trend ◽

Cox Proportional Hazards ◽

Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

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Factor analysis for the clustering of cardiometabolic risk factors and sedentary behavior, a cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0242365 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242365

Author(s):

Tsung-Ying Tsai ◽

Pai-Feng Hsu ◽

Chung-Chi Lin ◽

Yuan-Jen Wang ◽

Yaw-Zon Ding ◽

...

Keyword(s):

Risk Factors ◽

Factor Analysis ◽

General Population ◽

Sedentary Behavior ◽

Cardiometabolic Risk ◽

Cardiometabolic Risk Factors ◽

Validation Group ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Clustering Pattern

Background Few studies have reported on the clustering pattern of CVD risk factors, including sedentary behavior, systemic inflammation, and cadiometabolic components in the general population. Objective We aimed to explore the clustering pattern of CVD risk factors using exploratory factor analysis to investigate the underlying relationships between various CVD risk factors. Methods A total of 5606 subjects (3157 male, 51.5±11.7 y/o) were enrolled, and 14 cardiovascular risk factors were analyzed in an exploratory group (n = 3926) and a validation group (n = 1676), including sedentary behaviors. Results Five factor clusters were identified to explain 69.4% of the total variance, including adiposity (BMI, TG, HDL, UA, and HsCRP; 21.3%), lipids (total cholesterol and LDL-cholesterol; 14.0%), blood pressure (SBP and DBP; 13.3%), glucose (HbA1C, fasting glucose; 12.9%), and sedentary behavior (MET and sitting time; 8.0%). The inflammation biomarker HsCRP was clustered with only adiposity factors and not with other cardiometabolic risk factors, and the clustering pattern was verified in the validation group. Conclusion This study confirmed the clustering structure of cardiometabolic risk factors in the general population, including sedentary behavior. HsCRP was clustered with adiposity factors, while physical inactivity and sedentary behavior were clustered with each other.

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Abstract P113: Female Gender is Associated with a Low Ankle Brachial Index in the General Population

Circulation ◽

10.1161/circ.133.suppl_1.p113 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Ridhima Kapoor ◽

Colby Ayers ◽

Jacquelyn Kulinski

Keyword(s):

Risk Factors ◽

Gender Differences ◽

General Population ◽

Ankle Brachial Index ◽

Hdl Cholesterol ◽

Female Gender ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Health And Nutrition ◽

And Gender

Background: The ankle-brachial index (ABI) is a predictor of cardiovascular events, mortality and functional status. Gender differences in ABI have been reported in some population studies. Differences in height might account for these observed gender differences, but findings are conflicting. Objective: This study investigated the association between gender, height and ABI in the general population, independent of traditional cardiovascular disease (CVD) risk factors. Methods: Participants ≥ 40 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 with ABI data, were included. A low ABI was defined as a value < 1.0 (including borderline values). Sample-weighted multivariable logistic regression modeling was performed with low ABI as the dependent variable and height and gender as primary predictor variables of interest. A backward elimination model selection technique was performed to identify significant covariates. Results: There were 3,052 participants with ABI data (mean age 57, 51% female (1570 of 3052). The sample-weighted mean (±SE) ABI was 1.09 (±0.006) and 1.13 (±0.005) for females and males, respectively. Women were more likely to have a low ABI compared to men, 42% (659 of 1570) versus 28% (415 of 1482), respectively (p<0.0001). Female gender was associated with a low ABI (OR 1.34, [95% CI, 1.04-1.72]; p=0.025), independent of traditional CVD risk factors (see Figure). Age, diabetes, tobacco use, known CVD, BMI and black race were also associated with a low ABI (all p<0.003). Self-reported hypertension and non-HDL cholesterol levels, however, were not associated with a low ABI. An interaction between height and body mass index (BMI) was identified. Conclusions: Female gender is associated with a low ABI in the general population. This association appears to be independent of height and other traditional CVD risk factors and warrants further investigation.

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Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study

Circulation ◽

10.1161/circ.125.suppl_10.ap287 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Virginia J Howard ◽

Suzanne E Judd ◽

Abraham J Letter ◽

Dawn O Kleindorfer ◽

Leslie A McClure ◽

...

Keyword(s):

Sex Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

National Data ◽

Stroke Incidence ◽

The Difference ◽

Regards Study

Background: There are strikingly few national data available to describe sex differences in age-specific stroke incidence. Methods: REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors. Results: There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure). Discussion: These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.

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