Abstract WP224: Should Carotid Bruit Be Abandoned as a Marker of Carotid Stenosis and Cardiovascular Disease in Older Persons? The Cardiovascular Health Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Omer Saeed ◽  
Hunain Aslam
Keyword(s):  
Cardiovascular Disease ◽  
At Risk ◽  
Ischemic Stroke ◽  
Physical Examination ◽  
Carotid Stenosis ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Elderly Persons

Importance: Auscultation for carotid bruit has been considered part of physical examination for over five decades. Objective: To test whether a carotid bruit (CB) can identify patients with internal carotid artery stenosis (50% or greater) and those at risk of myocardial infarction (MI), ischemic stroke and/or death among elderly persons. Methods: We analyzed data from the Cardiovascular Health Study a population-based, prospective observational cohort study of risk factors for cardiovascular disease in adults 65 years or older. CB was auscultated and maximum percent stenosis was assessed using duplex ultrasound at baseline visit. Longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years to identify incidence of ischemic stroke, MI and death using annual extensive clinical examinations and 6 monthly clinic visits, and contact by phone to ascertain occurrence of cardiovascular events. We performed Cox proportional hazards analysis to determine the effect of CB on incidence of MI, stroke and death during follow up after adjusting for potential confounders. Results: The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2466 (41.9%) were men. CB was identified in 361 (6.1%) of 5888 persons. Carotid stenosis (50% or greater) was identified in 79 of 361 person with CB (sensitivity of 28.6%). No CB was auscultated in 197 out of 276 patients with carotid stenosis (specificity of 94%). During follow-up, higher proportion of persons with CB experienced ischemic stroke (10.8% versus 7.2%, p=.01), MI (15.0% versus 8.9%,p=<.0001) and death (36.3% versus 21.7%,p=<.0001). There were no differences in the risk of stroke (HR 1.2, 95% CI 0.9-1.5) between persons with CB compared with those without CB in the multivariate analysis after adjusting for age, gender, race hypertension, diabetes and smoking. There was a significantly higher rate of death among persons with CB (HR 1.3, 95% CI (1.1-1.5; p-<.01) and MI (HR 1.4, 95% CI 1.0-1.8; p-.03) compared with those who did not after adjusting for potential confounders. Conclusions: In this study, CB was a not a reliable marker for identification of carotid stenosis and those at risk for ischemic stroke. The current analysis does not support continued use of carotid bruit as part of physical examination.

Abstract 19269: Relations and Predictive Value of Post-load and Fasting Glucose for Incident Cardiovascular Disease and Mortality in Older Adults: the Cardiovascular Health Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Erika Brutsaert ◽  
Sanyog Shitole ◽  
Mary Lou Biggs ◽  
Kenneth Mukamal ◽  
Ian De Boer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Old Age ◽  
Risk Prediction ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study

Introduction: Elders have a high prevalence of post-load hyperglycemia, which may go undetected with standard screening. Post-load glucose has shown more robust associations with cardiovascular disease (CVD) and death than fasting glucose, but data in advanced old age are sparse. Whether post-load glucose improves risk prediction for CVD and death after accounting for fasting glucose has not been examined. Methods: Fasting and 2-hour post-load glucose were measured at baseline (1989) and follow-up (1996) visits in a prospective study of community-dwelling adults initially ≥65 years old (Cardiovascular Health Study). To evaluate if previously reported associations of fasting and post-load glucose with incident CVD from the baseline visit persist later in life, and apply to mortality, we focused on the 1996 visit (n=2394). To determine the incremental value of post-load glucose for risk prediction, we examined whether it could significantly reclassify baseline (1989) participants (≤75 years) into cholesterol treatment categories based on recent guidelines (n=2542). Results: Among participants in the 1996 visit (mean age 77), there were 543 incident CVD events and 1698 deaths during median follow-up of 11.2 years. In fully adjusted models, both fasting and 2-hour glucose were associated with CVD (HR per SD, 1.13 [1.03-1.25] and 1.17 [1.07-1.28], respectively) and mortality (HR per SD, 1.12 [1.07-1.18] and 1.14 [1.08-1.20]). After mutual adjustment, however, the associations for fasting glucose with either outcome were abolished, but those for post-load glucose remained unchanged. Among subjects ≤75 years old in 1989, there were 416 CVD events and 740 deaths at 10-year follow-up. Post-load glucose did not enhance reclassification using the 7.5% 10-year risk threshold, nor did it improve the C-statistic. Conclusion: In adults surviving to advanced old age, post-load glucose was associated with CVD and mortality independently of fasting glucose, but not vice versa, although there was no associated improvement in risk prediction. These findings affirm the robust association of post-load glucose with CVD and death late in life, but do not support the value of routine oral glucose tolerance testing for prediction of these outcomes in older adults.

Abstract 58: Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander E Merkler ◽  
Traci Bartz ◽  
Hooman Kamel ◽  
Elsayed Z Soliman ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Cardiovascular Health ◽  
Proportional Hazards ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Short Term ◽  
Silent Myocardial Infarction

Background: Whether silent myocardial infarction (MI) is a risk factor for ischemic stroke remains uncertain. Hypothesis: Silent MI is associated with incident ischemic stroke. Methods: The Cardiovascular Health Study prospectively enrolled community-dwelling individuals ≥65 years of age with follow-up through June 30, 2015. For this study, we included participants from the first study cohort (enrolled in 1989-1990) without prevalent stroke or baseline electrocardiographic (ECG) evidence of MI. Our exposures were silent and clinically apparent MI. Silent MI was defined as new evidence of Q-wave MI, without clinical symptoms of MI, on ECGs performed during annual study visits from 1989-1999. Clinically apparent (overt) MI was adjudicated on the basis of information about chest pain, ECG changes, and cardiac enzymes. The primary outcome was incident ischemic stroke. Secondary outcomes were ischemic stroke subtypes: non-lacunar, lacunar, and other/unknown. Cox proportional hazards analysis was used to model the association between time-varying MI status (silent, overt, or no MI) and stroke after adjustment for baseline demographics and vascular risk factors. Due to a violation of the proportional hazards assumption, the association between overt MI and stroke was modeled separately for short-term (within 30 days) and long-term (beyond 30 days) risk. Results: Among 4,224 participants included in this analysis, 362 (8.6%) had an incident silent MI, 421 (10.0%) an incident overt MI, and 377 (8.9%) an incident ischemic stroke during a median follow-up of 9.8 years. After adjustment for demographics and comorbidities, silent MI was independently associated with subsequent ischemic stroke (HR, 1.47; 95% CI, 1.01-2.16). Overt MI was associated with ischemic stroke both in the short term (HR, 80; 95% CI, 53-119) and long term (HR, 1.60; 95% CI, 1.04-2.44). In secondary analyses, the association between silent MI and stroke was limited to non-lacunar ischemic stroke (HR 2.18; 95% CI, 1.24-3.83). Conclusions: In a community-based sample, we found an association between silent MI and ischemic stroke, specifically non-lacunar stroke. These findings suggest that silent MI may be a novel risk factor for ischemic stroke.

Abstract TP172: Effect of Playing Golf on Cardiovascular Diseases and Death in Older Persons: The Cardiovascular Health Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Omar Saeed ◽  
M. Fareed K Suri
Keyword(s):  
Multivariate Analysis ◽  
Cardiovascular Diseases ◽  
Cardiovascular Events ◽  
Cardiovascular Health ◽  
Population Based ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Elderly Persons ◽  
Clinic Visits

Importance: Golf is played by about 25 million people in United States and may reduce the risk of cardiovascular diseases by providing regular exercise and stress relief. Objective: To test whether playing golf regularly reduces the risk of myocardial infarction (MI), stroke and/or death among elderly persons. Design, Settings, and Participants: We analyzed data from the Cardiovascular Health Study (CHS), an NHLBI-funded the population-based, prospective observational cohort study of risk factors for cardiovascular disease in adults 65 years or older. Starting in 1989, and continuing through 1999, participants underwent annual extensive clinical examinations and 6 monthly clinic visits, and once clinic visits ended, participants were contacted by phone to ascertain occurrence of cardiovascular events. Golf status was inquired at baseline and longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years. Persons who played golf for at least 1 month per year were considered as regular golf players. We performed Cox proportional hazards analysis to determine the effect of playing golf on incident MI, stroke, and death during follow up after adjusting for potential confounders. Results: The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2466 (41.9%) were men. Golf was played regularly by 384 persons. During follow-up, 31 (8.1%) participants had stroke and 38 (9.9%) had MI. Overall mortality rate was 1,115 deaths per 100,000 population. There was a significantly lower rate of death among persons who played golf regularly compared with those who did not (24.6% vs 15.1%). There was no difference in the rates of MI or stroke among those who played golf regularly. In the multivariate analysis, death was less likely among persons who played golf regularly (HR 0.6, 95% CI (0.4-0.7; p-<.0001) compared with those who did not after adjusting for age, race, gender, hypertension and diabetes mellitus. Their risk of MI (HR 1.0, 95% CI 0.7-1.3) or stroke (HR 1.0, 95% CI 0.7-1.5) was not lower among golf players in the multivariate analysis. Conclusions: In this large, population-based study, elderly persons who played golf were at lower risk of death. However, the protective effect of playing golf was not related to reduction in cardiovascular events.

Abstract 2568: Cerebral Infarcts in Blacks vs Whites: the Southall and Brent REvisited (SABRE) Multi-ethnic Cohort Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dean Shibata ◽  
Therese Tillin ◽  
Norman Beauchamp ◽  
John Heasman ◽  
Wadyslaw Gedroyc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Health ◽  
African Descent ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Stroke Mortality ◽  
Black African ◽  
Cerebral Mri ◽  
Mri Scans

Introduction: Stroke mortality is doubled in people of Black African descent compared with Whites, but factors responsible for this excess are unclear. We wished to compare infarct like lesions (ILL) on MRI by ethnicity and the role of risk factors. Methods: SABRE is a UK community based multi-ethnic cohort of men and women aged 40-69 years at baseline (1988-1990), and 58-86 years at follow up (2008-2011). At follow up, a questionnaire was completed and investigations performed including resting and ambulatory BP, anthropometry, and bloods for glucose and lipids. Cerebral MRI scans were scored for infarcts independently by two readers according to the Cardiovascular Health Study protocol. Results: Of 2346 Whites, 684 attended follow up, and 590 completed cerebral MRI. Of 801 Blacks (first generation migrants of Black African descent to the UK), 232 attended clinic and 207 completed MRI. Mortality loss was greater in Whites (605, 25%) than Blacks (121, 15%)(p<0.0001), although stroke was more likely the underlying cause in Blacks (23, 19%), than Whites (43, 7%)(p<0.0001) . Baseline systolic/diastolic BP was similarly higher in Blacks than Whites in attendees (8/5 mmHg), non-responders (7/6 mm Hg), and those who died (8/5 mmHg). At follow up stroke risk factors were adverse in Blacks, apart from smoking ( table ). Prevalence of ILL was similar by ethnicity, not differing when those <65 years were analysed separately, or when those with stroke/TIA history were excluded. Associations between ILL and risk factors did not differ by ethnicity. But prescribed treatment in those with elevated clinic BP (≥140 mmHg systolic, or ≥90 mmHg diastolic) was 83% in Blacks, 63% in Whites (p<0.0001). Further, in those with an ILL, 95% of Blacks, and 69% (p<0.0001) of Whites were on treatment. Conclusion: Equivalence of ILL rates in Blacks and Whites was unanticipated, given the greater stroke mortality in Blacks. Mitigating against selective mortality as the explanation of our findings is the similar ethnic differential in baseline BP in survivors and non-survivors, the lower overall mortality in Blacks, and overall small numbers of stroke deaths. A more likely explanation is that better targeted more aggressive treatment is now occurring in Blacks than Whites, reducing their potential burden of ILL.

Sign in / Sign up

Export Citation Format

Share Document