Abstract P57: Risk Factors for Incidentally Discovered Silent Brain Infarcts and White Matter Disease in a Real World Cohort Identified by Artificial Intelligence

Introduction: Silent brain infarcts (SBIs) and white matter disease (WMD) are highly prevalent and associated with increased risk of ischemic stroke in patients with traditional stroke risk factors (RFs) in prospective cohort studies. Their frequency and associations with stroke RFs have not been well described in real world populations. Methods: This was a cross-sectional study of patients age ≥ 50 in the Kaiser Permanente-Southern California (KPSC) health system between 2009-2019 with a head CT or MRI for non-stroke indications and no history of ischemic stroke, transient ischemic attack, or dementia. A natural language processing (NLP) algorithm developed at Mayo Clinic and Tufts Medical Center was applied to the KPSC EHR to identify individuals with reported SBIs or WMD. Multivariable Poisson regression with robust error variance was used to estimate risk ratios of demographics, stroke RFs (from the Framingham Stroke Risk Score), and scan modality on the presence of SBIs or WMD. Results: Among 262,875 individuals, the NLP identified 13,154 (5.0%) with SBIs and 78,330 (29.8%) with WMD. Stroke RFs were highly prevalent in this cohort. The majority underwent CTs (74.8%) instead of MRIs as their initial neuroimaging. After adjustment for demographics and RFs, advanced age demonstrated a strong association with increased risk of SBIs and WMD (table). MRI was associated with a reduced risk of reported SBIs (ARR: 0.87, 95% CI 0.83-0.91) and an increased risk of reported WMD (ARR 2.86, 95% CI 2.83-2.90). Despite being prevalent, traditional stroke RFs had weak associations with increased risk of SBIs or increased risk of WMD. Conclusions: Advanced age is strongly associated with incidentally discovered SBIs and WMD on neuroimaging studies obtained in routine care. The development of SBIs and WMD may not be fully attributable to traditional stroke RFs.

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Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study

Stroke ◽

10.1161/str.48.suppl_1.tmp58 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Anne-Katrin Giese ◽

Markus D Schirmer ◽

Adrian V Dalca ◽

Ramesh Sridharan ◽

Lisa Cloonan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Ischemic Stroke ◽

White Matter ◽

Stroke Risk ◽

Smoking Status ◽

Vascular Risk Factors ◽

White Matter Hyperintensity ◽

Vascular Risk ◽

Prior Stroke

Introduction: White matter hyperintensity (WMH) is a highly heritable trait and a significant contributor to stroke risk and severity. Vascular risk factors contribute to WMH severity; however, knowledge of the determinants of WMH in acute ischemic stroke (AIS) is still limited. Hypothesis: WMH volume (WMHv) varies across AIS subtypes and is modified by vascular risk factors. Methods: We extracted WMHv from the clinical MRI scans of 2683 AIS subjects from the MRI-Genetics Interface Exploration (MRI-GENIE) study using a novel fully-automated, volumetric analysis pipeline. Demographic data, stroke risk factors and stroke subtyping for the Causative Classification of Stroke (CCS) were performed at each of the 12 international study sites. WMHv was natural log-transformed for linear regression analyses. Results: Median WMHv was 5.7cm 3 (interquartile range (IQR): 2.2-12.8cm 3 ). In univariable analysis, age (63.1 ± 14.7 years, β=0.04, SE=0.002), prior stroke (10.2%, β=0.66, SE=0.08), hypertension (65.4%, β=0.75, SE=0.05), diabetes mellitus (23.1%, β=0.35, SE=0.06), coronary artery disease (17.6%, β=0.04, SE=0.002), and atrial fibrillation (14.6%, β=0.48, SE=0.07) were significant predictors of WMHv (all p<0.0001), as well as smoking status (52.2%, β=0.15, SE=0.05, p=0.005), race (16.5% Non-Caucasian, β=0.25, SE=0.07) and ethnicity (8.2% Hispanic, β=0.30, SE=0.11) (all p<0.01). In multivariable analysis, age (β=0.04, SE=0.002), prior stroke (β=0.56, SE=0.08), hypertension (β=0.33, SE=0.05), smoking status (β=0.16, SE=0.05), race (β=0.42, SE=0.06), and ethnicity (β=0.34, SE=0.09) were independent predictors of WMHv (all p<0.0001), as well as diabetes mellitus (β=0.13, SE=0.06, p=0.02). WMHv differed significantly (p<0.0001, unadjusted) across CCS stroke subtypes: cardioembolic stroke (8.0cm 3 , IQR: 4.2-15.4cm 3 ), large-artery stroke (6.9cm 3 , IQR: 3.1-14.7cm 3 ), small-vessel stroke (5.8cm 3 , IQR: 2.5-13.5cm 3 ), stroke of undetermined (4.7cm 3 , IQR: 1.6-11.0cm 3 ) or other (2.55cm 3 , IQR: 0.9-8.8cm 3 ) causes. Conclusion: In this largest-to-date, multicenter hospital-based cohort of AIS patients with automated WMHv analysis, common vascular risk factors contribute significantly to WMH burden and WMHv varies by CCS subtype.

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Premature Atrial Contractions on the Screening Electrocardiogram and Risk of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

Neuroepidemiology ◽

10.1159/000448619 ◽

2016 ◽

Vol 47 (1) ◽

pp. 53-58 ◽

Cited By ~ 13

Author(s):

Wesley T. O'Neal ◽

Hooman Kamel ◽

Dawn Kleindorfer ◽

Suzanne E. Judd ◽

George Howard ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Racial Differences ◽

Stroke Risk ◽

Cox Regression ◽

Stroke Risk Factors ◽

Stroke Study ◽

Increased Risk ◽

Study Participants ◽

The Relationship

Background: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. Methods: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline. Cox regression was used to examine the association between PACs and ischemic stroke events through March 31, 2014. Results: PACs were present in 1,687 (7.3%) participants at baseline. In a Cox regression model adjusted for stroke risk factors and potential confounders, PACs were associated with an increased risk of ischemic stroke (hazards ratio (HR) 1.34, 95% CI 1.04-1.74). The relationship was limited to non-lacunar infarcts (HR 1.42, 95% CI 1.08-1.87), and not lacunar strokes (HR 1.01, 95% CI 0.51-2.03). An interaction by sex was detected, with the association between PACs and ischemic stroke being stronger among women (HR 1.82, 95% CI 1.29-2.56) than men (HR 1.03, 95% CI 0.69-1.52; p-interaction = 0.0095). Conclusion: PACs detected on the routine electrocardiogram are associated with an increased risk for non-lacunar ischemic strokes, especially in women.

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Abstract P604: Incidentally-Discovered Asymptomatic Ischemic Lesions Identified Using Natural Language Processing Are Strong Risk Markers for Future Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p604 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

David M Kent ◽

Lester Y Leung ◽

Yichen Zhou ◽

Patrick H Luetmer ◽

David F Kallmes ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Natural Language Processing ◽

Natural Language ◽

Language Processing ◽

Stroke Risk ◽

Risk Markers ◽

Stroke Risk Factors ◽

Over Time ◽

Major Stroke

Background: White matter disease (WMD) and silent brain infarction (SBI) are known to be risk markers for stroke. Nevertheless, the predictive value of these changes when seen incidentally on routinely-obtained neuroimages is unknown. Methods: In this retrospective cohort study, Kaiser Permanente-Southern California health plan enrollees aged ≥ 50 years old with a brain CT or MRI scan between 2009-2019 and without a prior history of ischemic stroke, transient ischemic attack, or dementia were identified. Natural language processing (NLP) was used to identify patients with SBI and WMD on the index neuroimaging report. We used Cox proportional hazards to estimate the risk of future ischemic stroke associated with the presence of SBI and of WMD, controlling for major stroke risk factors. Results: Among 262,875 individuals receiving brain neuroimaging, 13,154 (5.0%) and 78,330 (29.8%) had SBI and WMD, respectively. The Table below summarizes the crude stroke incidence rates. The crude hazard ratio (HR) was 3.40 (95% CI 3.25-3.56) for SBI and 2.63 (95% CI 2.54-2.71) for WMD. In the multivariable model controlling for all major stroke risk factors, the effect of SBI was found to be stronger in younger versus older patients and for MRI- versus CT-discovered lesions. With MRI, the average adjusted HR over time was 2.95 (95% CI 2.53-3.44) for those < age 65 and 2.15 (95% CI 1.91-2.41) for those ≥ age 65. With CT scan, the average adjusted HR over time was 2.48 (95%CI 2.19-2.81) for those < age 65 and 1.81 (95% CI 1.71-1.91) for those ≥ age 65. The adjusted HR associated with a finding of WMD was 1.76 (95% CI 1.69-1.82) and was not modified by age or imaging modality. The effect of SBI decreased gradually over time, while the effect of WMD remained constant. Conclusion: Incidentally-discovered SBI and WMD are common in patients ≥ age 50 and are associated with substantial increases in the risk of subsequent symptomatic stroke. The findings may represent an opportunity for stroke prevention.

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Abstract 54: Procalcitonin, Copeptin and Midregional Pro-atrial Natriuretic Peptide as Markers of Ischemic Stroke Risk: The Northern Manhattan Study

Stroke ◽

10.1161/str.45.suppl_1.54 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Mira Katan ◽

Yeseon P Moon ◽

Janet DeRosa ◽

Myunghee C Paik ◽

Beat Mueller ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Ischemic Stroke ◽

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Stroke Risk ◽

Hemodynamic Stress ◽

Increased Risk ◽

Ischemic Stroke Risk ◽

Atrial Natriuretic

Background: Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke. We hypothesized that selected blood biomarkers of infection (procalcitonin, or PCT), hypothalamic-pituitary-axis function (copeptin), and hemodynamic stress (midregional pro-atrial natriuretic peptide, or MRproANP) would be associated with incident ischemic stroke risk in the multi-ethnic, urban Northern Manhattan Study (NOMAS) cohort. Methods: A case-cohort study was performed among initially stroke-free participants from the prospective population-based NOMAS study. The mean follow up was 11 years. Cases were defined as first ischemic stroke (including fatal) with available baseline blood (n=172). We randomly selected controls among those who did not develop an event (n=344). Biomarkers were measured in a blinded batch analysis (Laboratory of the Medical University Clinic, Aarau, Switzerland, using B.R.A.H.M.S assays by Thermo Fisher Scientific). We calculated hazard ratios and 95% confidence intervals (HR, 95% CI) using Cox proportional hazards models, with inverse probability weighting to correct for the case-cohort study design, to estimate the association with risk of stroke after adjusting for demographic, behavioral, and medical risk factors. Results: Mean age of cases was 72 (IQR 65-78); 59% were female. After full adjustment, those with PCT in the top quartile, compared to the lowest quartile, were at increased risk of ischemic stroke (adjusted HR 1.98, 95% CI 1.02-3.83). Those with MRproANP levels in the top quartile, compared to the lowest quartile, were also at increased risk of stroke (adjusted HR 3.45, 95% CI 1.58-7.52), but not those with higher copeptin levels. The distribution of MRproANP differed by stroke etiology. Levels of MRproANP were greater for cardioembolic strokes (CE), and MRproANP levels were predictive of CE (adjusted HR 3.29 per SD, 95% CI 1.89-5.72). Conclusion: Higher levels of procalcitonin, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with ischemic stroke risk in this multiethnic, urban cohort. MRproANP was specifically associated with cardioembolic stroke risk. Further study is needed to confirm these results.

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Abstract P418: Increased Pro-neurotensin/neuromedin N is Associated With Incident Ischemic Stroke

Circulation ◽

10.1161/circ.141.suppl_1.p418 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Charles D Nicoli ◽

Nicholas Wettersten ◽

George Howard ◽

Virginia J Howard ◽

Suzanne E Judd ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Racial Differences ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Disease Risk ◽

Stroke Risk Factors ◽

Increased Risk ◽

Ischemic Stroke Risk ◽

Neuromedin N

Introduction: The neuropeptide neurotensin (NT) has been linked to cardiovascular and metabolic disease risk. Through measurement of its stable equimolar precursor, pro-neurotensin/neuromedin N (pro-NT/NMN), hyperactivity of NT has been associated with aggregate cardiovascular outcomes that include stroke. However, the exclusive association of pro-NT/NMN with incident ischemic or hemorrhagic stroke has not been studied. Hypothesis: Higher serum pro-NT/NMN is associated with incident ischemic and hemorrhagic stroke. Methods: Prospective case-cohort study in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. From 2003-2007, REGARDS enrolled 30,239 White or Black adults aged ≥45. Pro-NT/NMN was measured by immunoassay in 464 ischemic stroke cases, 49 hemorrhagic stroke cases, and 800 non-cases from a random cohort. Cox proportional-hazards models were used to calculate hazard ratios (HR) of stroke by pro-NT/NMN quartiles and per standard deviation (SD) of log pro-NT/NMN. Model 1 (both stroke types) included demographic factors as covariates, Model 2A (ischemic only) added ischemic stroke risk factors, and Model 2B (hemorrhagic only) added hemorrhagic stroke risk factors. Results: The table shows an increased HR of ischemic stroke for those in the 4th vs 1st-quartile pro-NT/NMN in Model 1 with a trend of increased risk across quartiles; this was attenuated in Model 2A. Prebaseline diabetes and coronary artery disease were the largest confounders of ischemic stroke risk, with each accounting for 19% of the association observed in Model 1. There was no association of pro-NT/NMN with hemorrhagic stroke in either model. There were no interactions of race or sex with log pro-NT/NMN. Conclusions: Higher pro-NT/NMN is associated with increased risk of ischemic stroke after adjusting for demographics, but this was not independent of stroke risk factors. No significant association with hemorrhagic stroke was observed; this analysis was limited by a small number of events.

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Gastrointestinal Disorders and Risk of First-Ever Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.030643 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3577-3583

Author(s):

William H. Roth ◽

Anna Cai ◽

Cenai Zhang ◽

Monica L. Chen ◽

Alexander E. Merkler ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Gut Microbiome ◽

Stroke Risk ◽

Proportional Hazards ◽

Gastrointestinal Diseases ◽

Cox Proportional Hazards ◽

Gastrointestinal Disorders ◽

Stroke Risk Factors ◽

Increased Risk

Background and Purpose: Recent studies suggest that alteration of the normal gut microbiome contributes to atherosclerotic burden and cardiovascular disease. While many gastrointestinal diseases are known to cause disruption of the normal gut microbiome in humans, the clinical impact of gastrointestinal diseases on subsequent cerebrovascular disease remains unknown. We conducted an exploratory analysis evaluating the relationship between gastrointestinal diseases and ischemic stroke. Methods: We performed a retrospective cohort study using claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. We included only beneficiaries ≥66 years of age. We used previously validated diagnosis codes to ascertain our primary outcome of ischemic stroke. In an exploratory manner, we categorized gastrointestinal disorders by anatomic location, disease chronicity, and disease mechanism. We used Cox proportional hazards models to examine associations of gastrointestinal disorder categories and ischemic stroke with adjustment for demographics and established vascular risk factors. Results: Among a mean of 1 725 246 beneficiaries in each analysis, several categories of gastrointestinal disorders were associated with an increased risk of ischemic stroke after adjustment for established stroke risk factors. The most notable positive associations included disorders of the stomach (hazard ratio, 1.17 [95% CI, 1.15–1.19]) and functional (1.16 [95% CI, 1.15–1.17]), inflammatory (1.13 [95% CI, 1.12–1.15]), and infectious gastrointestinal disorders (1.13 [95% CI, 1.12–1.15]). In contrast, we found no associations with stroke for diseases of the anus and rectum (0.97 [95% CI, 0.94–1.00]) or neoplastic gastrointestinal disorders (0.97 [95% CI, 0.94–1.00]). Conclusions: In exploratory analyses, several categories of gastrointestinal disorders were associated with an increased risk of future ischemic stroke after adjustment for demographics and established stroke risk factors.

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Agreement between neuroimages and reports for natural language processing-based detection of silent brain infarcts and white matter disease

BMC Neurology ◽

10.1186/s12883-021-02221-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lester Y. Leung ◽

Sunyang Fu ◽

Patrick H. Luetmer ◽

David F. Kallmes ◽

Neel Madan ◽

...

Keyword(s):

Natural Language Processing ◽

White Matter ◽

Natural Language ◽

Language Processing ◽

Interrater Reliability ◽

Clinical Care ◽

Routine Care ◽

White Matter Disease ◽

Brain Infarcts ◽

Cohort Identification

Abstract Background There are numerous barriers to identifying patients with silent brain infarcts (SBIs) and white matter disease (WMD) in routine clinical care. A natural language processing (NLP) algorithm may identify patients from neuroimaging reports, but it is unclear if these reports contain reliable information on these findings. Methods Four radiology residents reviewed 1000 neuroimaging reports (RI) of patients age > 50 years without clinical histories of stroke, TIA, or dementia for the presence, acuity, and location of SBIs, and the presence and severity of WMD. Four neuroradiologists directly reviewed a subsample of 182 images (DR). An NLP algorithm was developed to identify findings in reports. We assessed interrater reliability for DR and RI, and agreement between these two and with NLP. Results For DR, interrater reliability was moderate for the presence of SBIs (k = 0.58, 95 % CI 0.46–0.69) and WMD (k = 0.49, 95 % CI 0.35–0.63), and moderate to substantial for characteristics of SBI and WMD. Agreement between DR and RI was substantial for the presence of SBIs and WMD, and fair to substantial for characteristics of SBIs and WMD. Agreement between NLP and DR was substantial for the presence of SBIs (k = 0.64, 95 % CI 0.53–0.76) and moderate (k = 0.52, 95 % CI 0.39–0.65) for the presence of WMD. Conclusions Neuroimaging reports in routine care capture the presence of SBIs and WMD. An NLP can identify these findings (comparable to direct imaging review) and can likely be used for cohort identification.

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Low ADAMTS13 activity is associated with an increased risk of ischemic stroke

Blood ◽

10.1182/blood-2015-05-643338 ◽

2015 ◽

Vol 126 (25) ◽

pp. 2739-2746 ◽

Cited By ~ 66

Author(s):

Michelle A. H. Sonneveld ◽

Moniek P. M. de Maat ◽

Marileen L. P. Portegies ◽

Maryam Kavousi ◽

Albert Hofman ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Stroke Risk ◽

Adamts13 Activity ◽

Increased Risk ◽

Key Points ◽

Ischemic Stroke Risk ◽

Traditional Risk Factors

Key Points Low ADAMTS13 activity is associated with ischemic stroke. ADAMTS13 activity improved the accuracy of ischemic stroke risk predictions beyond the traditional risk factors.

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Polymorphisms in Inflammatory Genes and the Risk of Ischemic Stroke and Transient Ischemic Attack: Results of a Multilocus Genotyping Assay

Clinical Chemistry ◽

10.1373/clinchem.2008.112151 ◽

2009 ◽

Vol 55 (1) ◽

pp. 134-138 ◽

Cited By ~ 15

Author(s):

Stefan Greisenegger ◽

Sonja Zehetmayer ◽

Peter Bauer ◽

Georg Endler ◽

Julia Ferrari ◽

...

Keyword(s):

Risk Factors ◽

Genetic Variation ◽

Regression Analysis ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Stroke Risk ◽

Conditional Logistic Regression ◽

Pcr Analysis ◽

Increased Risk ◽

Ischemic Attack

Abstract Background: Single-nucleotide polymorphisms (SNPs) in inflammation-related genes have been linked to an increased risk of ischemic stroke. Most of these SNP results have not been replicated, however, and metaanalyses of the effects of inflammation-related genes are rare. We investigated 49 SNPs in 34 genes previously reported to be related to inflammation in our study. We tested 459 patients with acute ischemic stroke or transient ischemic attack and 459 controls individually matched by sex and age. Methods: We studied genetic variation by PCR analysis and subsequent hybridization to linear arrays of sequence-specific oligonucleotides. We used univariate conditional logistic regression analysis to test for associations of conventional vascular risk factors and the SNPs with stroke. Variables showing significant differences (P < 0.05) between cases and controls were included in a multivariate model. ROC curves were plotted to assess the contribution of genetic variation to stroke risk in addition to that of conventional risk factors. Results: Univariate regression analysis revealed 3 SNPs with significant allelic differences between patients and controls, which fulfilled the criteria for further analysis. Only one of these SNPs, the C5 (complement component 5) 2416A>G variant (rs17611), remained significant after the multivariate analysis (odds ratio, 0.585; P = 0.0037). ROC curve analysis revealed no contribution of this genetic variation to stroke risk. Conclusions: We found evidence for an association of the 2416A>G polymorphism in the C5 gene with the risk for ischemic stroke. Our data suggest that the C5 gene particularly influences the risk for patients with microangiopathy.

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Abstract 111: Depression as a Risk Factor for Incident Ischemic Stroke Among HIV-infected Veterans

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.111 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Jason J Sico ◽

Suman Kundu ◽

Kaku So-Armah ◽

Samir Gupta ◽

Joyce Chang ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Alcohol Abuse ◽

Stroke Risk ◽

Future Research ◽

Sociodemographic Characteristics ◽

Cerebrovascular Risk Factors ◽

Increased Risk ◽

Cerebrovascular Risk

Background: HIV infection (HIV+) and major depressive disorder (MDD) are each associated with an increased risk of ischemic stroke. While depressive disorders are common among HIV+ people, it is not known if MDD is a risk factor for ischemic stroke in the HIV population. Methods and Results: We analyzed data on 106,363 (33,544 HIV+; 72,819 HIV-) participants who were free of baseline cardiovascular disease from the Veterans Aging Cohort Study, an observational cohort of HIV+ and matched uninfected veterans in care from April 1 st , 2003 through September 30, 2012. International Classification of Diseases, Ninth Revision codes from medical records were used to determine baseline MDD and the primary outcome, incident ischemic stroke. The prevalence of MDD was similar for HIV+ and HIV- veterans (20.0% and 18.8%, respectively). After a median of 9.2 years of follow-up, stroke rates per 1000 person-years were highest among HIV+/MDD+ veterans (5.8; 95% CI:5.2-6.5), followed by HIV+/MDD- veterans (5.3; 95% CI:5.0-5.6), HIV-/MDD+ (5.1; 95% CI: 4.7-5.5), and HIV-/MDD- (4.8; 95% CI: 4.6-5.0). In Cox proportional hazard models, MDD was associated with an increased risk of ischemic stroke for both HIV+ and HIV- veterans, even after adjusting for sociodemographic adjusting for sociodemographic characteristics and cerebrovascular risk factors (Table). The risk persisted among HIV+ people after further adjusting for HIV factors (Table). These associations were modestly attenuated with the addition of cocaine and alcohol abuse/dependence. Conclusions: In the VACS, MDD was associated with an increased risk of ischemic stroke in HIV+ veterans after adjustment for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV factors; however, this association was modestly attenuated after adjustment for cocaine and alcohol abuse/dependence. Future research is necessary to: (a) fully elucidate the relationships among MDD, cocaine/alcohol use, and stroke risk and (b) determine whether intervening on MDD reduces stroke risk in HIV+ and HIV- people. Clinical providers should be aware of the increased stroke risk among HIV+ adults with MDD.

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