Association between Family History of Stroke and Stroke Risk: A Community Survey

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

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Abstract P714: Knowledge of Stroke Warning Signs and Risk Factors in Minnesota Adults

Stroke ◽

10.1161/str.52.suppl_1.p714 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Niloufar N Hadidi ◽

Meghan K Tierney ◽

Jane Claeys ◽

Olga V Gurvich

Keyword(s):

Risk Factors ◽

Family History ◽

Risk Score ◽

Stroke Risk ◽

Lifestyle Changes ◽

Warning Signs ◽

Warning Sign ◽

Cross Sectional Survey ◽

Stroke Risk Factors ◽

History Of

Background: Global Burden of Disease identified stroke as the second leading cause of death worldwide after ischemic heart disease. Many stroke risk factors are preventable with lifestyle changes. A better understanding of the relationship between demographics and knowledge of stroke risk factors and warning signs may help in identifying target populations for preventative stroke education. Purpose: This study aimed to explore 1)knowledge of stroke risk factors and warning signs among Minnesota adults, 2)association between knowledge of risk factors and presence of risk factors and 3)association between the knowledge of warning signs and family history of stroke. Methods: A cross-sectional survey of 207 consenting adults who completed open-ended questionnaires on identifying stroke risk factors and warning signs per American Stroke Association (ASA) was used. Self-reported demographics, medical/family history and lifestyle behaviors data were combined with measured height, weight and blood pressure to provide an individual stroke risk score per the ASA Stroke Risk Score. Results: Most participants(90.3%) correctly identified at least one stroke warning sign, but <1% identified all warning signs (FAST+Walking+Vision). 58.9% identified ≥3 stroke risk factors while only 2.4% identified 6 risk factors. Of the highest ranked stroke risk factors(hypertension, smoking, diabetes, diet, obesity, exercise, age, gender, atrial fibrillation), hypertension and obesity were the most named, correctly identified by 64.3% and 53.1% respectively. Females were slightly more knowledgeable of risk factors(63.9% females vs. 51.8% males) and warning signs(62.3% females vs. 58.8% males). No statistically significant associations were observed between knowledge of risk factors and presence of them, or between family history of stroke and knowledge of stroke warning signs. Conclusion: The findings of this study identified the need for public education of stroke risk factors and warning signs as a critical first step in behavior change. Gender differences in knowledge was slightly different. Other demographic differences was not identified due to study sample homogeneity. Additional efforts should be made to increase sample diversity in future studies.

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Abstract TMP50: Antihypertensive Medication Trends Among Individuals With History of Stroke and Hypertension: The National Health and Nutrition Examination Survey (NHANES) 2005 - 2016

Stroke ◽

10.1161/str.51.suppl_1.tmp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Daniel Santos ◽

Mandip S Dhamoon

Keyword(s):

Risk Factor ◽

National Health ◽

Stroke Risk ◽

Beta Blockers ◽

Stroke Survivors ◽

Nutrition Examination Survey ◽

Stroke Risk Factor ◽

Health And Nutrition ◽

History Of ◽

Over Time

Background: Hypertension (HTN) is a well-established, modifiable stroke risk factor. National HTN management trends among stroke survivors may provide important insight into secondary preventive treatment gaps. We investigated the adequacy of blood pressure (BP) control among stroke survivors and national antihypertensive (ATH) treatment trends. Methods: The National Health and Nutrition Examination Survey (NHANES) is a large, nationally representative cross-sectional survey conducted in 2-year cycles in the U.S. Evaluations include interviews, medication lists, physical examinations, and blood samples. We included participants aged >=20 years with HTN and history of stroke from 2005 to 2016. HTN was defined by self-report, ATH use, or uncontrolled HTN (BP >140/90) on physical examination. ATH medications were classified into calcium channel blockers, beta blockers, diuretics, and ACE inhibitors/angiotensin receptor blockers (ACE/ARBs). We report weighted frequencies and means using NHANES methodology, estimating the proportion of those with stroke with HTN. For all other analyses we examined those with stroke and HTN, summarizing number and classes of ATH, frequency of uncontrolled HTN, and associations between ATH classes and BP control. We examined trends in ATH use over time. Results: Among an estimated 6.4 million adults with history of stroke from 2005-2016, 78.2% had HTN but only 69.6% reported having been prescribed ATH medication. Among those with history of stroke and HTN (n=4971136), 37.1% (33.5-40.8%) had uncontrolled HTN on examination with 80.4% taking ATH. Most commonly used ATH medications were beta blockers (43.8%, 40.3-47.3%) and diuretics (41.5%, 37.2-45.8%). ATH classes associated with uncontrolled HTN included ACE/ARB (56.0%) and beta blockers (42.6%). Examining trends over time, diuretics have become less commonly used (49.4% in 2005-2006 vs. 35.7% in 2015-2016) whereas other classes remain more constant. Conclusion: Using a national survey, we found significant under-treatment of HTN in those with history of stroke, and >1/3 had uncontrolled HTN. Since HTN is a major stroke risk factor, this data demonstrates a significant missed opportunity nationally for secondary stroke prevention.

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Who Gets Inhibitors? Predicting Inhibitory Antibodies in Children with Severe Hemophilia A.

Blood ◽

10.1182/blood.v110.11.1158.1158 ◽

2007 ◽

Vol 110 (11) ◽

pp. 1158-1158

Author(s):

Petra C. ter Avest ◽

Kathelijn Fischer ◽

Elena Santagostino ◽

Marijke H. van den Berg ◽

Johanna G. van der Bom

Keyword(s):

Family History ◽

High Risk ◽

Risk Score ◽

Hemophilia A ◽

Positive Family History ◽

Treatment Strategies ◽

Intensive Treatment ◽

Severe Hemophilia ◽

Inhibitor Development ◽

History Of

Abstract Background. Replacement therapy in severe hemophilia A patients is complicated by formation of inhibitors in around 25% of children. Identification of patients at the highest risk may help to tailor personalized treatment strategies. Objectives. To develop a scoring system that may be used to identify patients at the highest risk of inhibitor development at first treatment. Methods. We used the data from a retrospective multicentre cohort study (the Canal cohort) of patients with severe hemophilia A (factor VIII (FVIII)less than 0.01 IU/ml), born 1990–2000, followed at least until their 50th exposure day. Presence of inhibitor was defined as twice a positive inhibitor titer and a decreased FVIII recovery. Based on the coefficients of a logistic regression model, a weighted risk-score was developed. Shrinkage of regression coefficients was used to control for overfitting. The discriminative ability of the risk-score was expressed as the area under the curve (AUC) of a receiver operating characteristic curve. Results. Out of the 366 patients from the Canal cohort, 284 children were selected of whom 78 developed an inhibitor (27%). Logistic regression analysis revealed 3 independent risk factors for inhibitor development: positive family history, intensive treatment (at least 5 consecutive days) at the first FVIII exposure, and high risk FVIII gene mutations. Table 1 presents odds ratios of the uni- and multivariate analyses, and the risk score. The AUC for the risk-score was 0,724. Table 2 shows that the model is able to separate high and low risk patients from patients with an intermediate risk of 25%. Conclusions. The risk score includes positive family history of inhibitors, high risk factor VIII gene mutation and intensive treatment at first FVIII exposure. This risk score can recognize patients with a doubled risk for inhibitor development and may be used to guide inhibitor preventive treatment strategies. Table 1. Uni- and Multivariate analysis and risk-score. OR (CI), Univariate OR (CI), Multivariate p-value Risk-Score CI = confidence interval 95% Positive Family History of Inhibitors 4.0 (1.7–9.4) 3.0 (1.2–7.7) ,022 3 High risk FVIII Gene Mutation 3.6 (1.8–7.2) 3.7 (1.8–7.9) ,001 4 Intensive Treatment at 1st FVIII exposure 6.8 (3.6–12.9) 7.2 (3.4–15.1) ,000 6 Table 2. Calibration of the risk-score. Model Total n° patients Predicted n° Inhibitors Observed n° Inhibitors Positive Predictive Value Negative Predictive Value LR= Low Risk, MR= Medium Risk, HR= High risk LR:0 72 7 6 0,34 0,92 MR:3–4 153 39 38 0,25 0,69 HR: >4 59 32 34 0,58 0,80

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Stroke and stroke risk factors as disease burden

Health Risk Analysis ◽

10.21668/health.risk/2021.4.16 ◽

2021 ◽

pp. 146-151

Author(s):

S. Ozturk ◽

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Diseases ◽

Cardiovascular Health ◽

Stroke Risk ◽

Heart Diseases ◽

Health Indicators ◽

The United States ◽

Blood Cholesterol ◽

Stroke Risk Factor

Stroke is the most common cause of disability and death in the world. Cardiovascular disease rates increase with age (10.9 % for people aged 20–30 years and 85.3 % for people older than 80 years). Coronary heart diseases is the leading cause of deaths attributable to cardiovascular diseases in the United States, followed by stroke, high BP, HF, diseases of the arteries, and other cardiovascular diseases. The report on the global burden of neurological disorders has shown that hemorrhagic stroke accounted for 35.7 % in it, and ischemic stroke, 22.4 %. Seven indicators are important and strategic to prevent cardiovascular disorders; they include healthy diet, sufficient physical activity, smokingstatius, BMI, cholesterol level, blood pressure, and glucose in blood on a fasting stomach. These indicators are associated with healthy behavior (diet quality, PA, smoking, BMI) which are as important as health factors (blood cholesterol, BP, blood glucose). There is a strong protective association between ideal cardiovascular health indicators and many clinical and preclinical conditions including premature all-cause mortality, stroke, CVD mortality, ischemic heart disease mortality, HF, deep venous thromboembolism, and pulmonary embolism. Atrial fibrillation, metabolic syndrome, renal failure, and sleep apnea are important risk factors which are modifiable and treatable. Air pollution has been reported as an increasing and very important risk factor for stroke. COVID-19 has been reported as another new stroke risk factor during the pandemic. Future targets must include each cardiovascular health indicator to decrease stroke risk burden and stroke risk.

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Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China

10.21203/rs.2.17357/v4 ◽

2019 ◽

Author(s):

Xingyang Yi ◽

Hua Luo ◽

Ju Zhou ◽

Ming Yu ◽

Xiaorong Chen ◽

...

Keyword(s):

Risk Factors ◽

Family History ◽

High Risk ◽

Population Attributable Risk ◽

Southwestern China ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Stroke Population ◽

History Of ◽

Lack Of Exercise

Abstract Background: Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China. Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The 8 communities were selected at random, and 17413 residents aged ≥ 40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. 521 participants with incomplete questionnaires on stroke history or risk factors records were excluded. Results: A total of 16892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6% - 3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82-8.23) was significantly associated with hemorrhagic stroke. Conclusions: The prevalence of stroke and high risk stroke population was high among adults aged ≥ 40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.

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Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China

BMC Neurology ◽

10.1186/s12883-019-1592-z ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Xingyang Yi ◽

Hua Luo ◽

Ju Zhou ◽

Ming Yu ◽

Xiaorong Chen ◽

...

Keyword(s):

Risk Factors ◽

Family History ◽

High Risk ◽

Population Attributable Risk ◽

Southwestern China ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Stroke Population ◽

History Of ◽

Lack Of Exercise

Abstract Background Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China. Methods This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The eight communities were selected at random, and 17,413 residents aged ≥40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. Five hundred twenty-one participants with incomplete questionnaires on stroke history or risk factors records were excluded. Results A total of 16,892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6–3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82–8.23) was significantly associated with hemorrhagic stroke. Conclusions The prevalence of stroke and high risk stroke population was high among adults aged ≥40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.

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Female sex as a risk factor for ischaemic stroke varies with age in patients with atrial fibrillation

Heart ◽

10.1136/heartjnl-2019-315065 ◽

2019 ◽

Vol 106 (7) ◽

pp. 534-540 ◽

Cited By ~ 6

Author(s):

Victor Chien-Chia Wu ◽

Michael Wu ◽

Victor Aboyans ◽

Shang-Hung Chang ◽

Shao-Wei Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Heart Disease ◽

Ischaemic Stroke ◽

Stroke Risk ◽

Research Database ◽

Stroke Risk Factor ◽

Female Sex ◽

Included Patient ◽

History Of

ObjectivesFemale sex is an inconsistent ischaemic stroke risk factor in patients with atrial fibrillation (AF). We hypothesised that the ischaemic stroke risk varies with age among women compared with men.MethodsWe retrieved the patients with newly diagnosed AF during 2001–2013 from Taiwan’s National Health Insurance Research Database. Patients with missing information, age <20 years, history of valvular heart disease and surgery, rheumatic heart disease, hyperthyroidism or anticoagulation and/or antiplatelet use were excluded. Propensity score matching (PSM) included patient comorbidities, medications and index date stratified by age and sex groups. Primary outcome was defined as ischaemic stroke at follow-up.ResultsAfter exclusion criteria, 87 369 men and 71 853 women remained for analysis (aged 73.1±14.4 years). After 1:1 PSM, we included 59 583 men (aged 73.5±13.7 years) and 59 583 women (aged 73.4±13.8 years) for analysis. We also stratified patients by age. The ischaemic stroke risk varied with age in women compared with men: lower in the ≤55 years (subdistribution HR (SHR)=0.75, 95% CI 0.62 to 0.90) and 56–65 years (SHR=0.87, 95% CI 0.78 to 0.98) groups, neutral in the 66–75 years group (SHR=1.01, 95% CI 0.94 to 1.08) and adverse in the >75 years group (SHR=1.14, 95% CI 1.09 to 1.19).ConclusionsThe female/male ischaemic stroke risk ratio varied with age. Only women aged >75 years had a higher risk, whereas women aged <65 years had a lower risk compared with men. These findings challenge the ‘sex category’ component of the CHA2DS2-VASc score, used to make decision regarding anticoagulation treatment in AF patients.

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Abstract P320: Discordance of Framingham Risk Score and Reynolds Risk Score to Global Vascular Risk Score: Results from the Hispanic Community Health Study/Study of Latinos

Circulation ◽

10.1161/circ.129.suppl_1.p320 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Molly Jung ◽

Hector M Medina ◽

Martha Daviglus ◽

Marina DelRios ◽

Mario Garcia ◽

...

Keyword(s):

Family History ◽

High Risk ◽

Risk Score ◽

Framingham Risk Score ◽

Demographic Characteristics ◽

Vascular Risk ◽

Framingham Risk ◽

Chd Risk ◽

History Of ◽

Reynolds Risk Score

Introduction: The Framingham Risk Score (FRS) is a coronary heart disease (CHD) risk model established using an ethnically homogeneous population that predicts 10-year hard CHD events, myocardial infarction (MI) and coronary death. The Reynolds Risk Score (RRS) and Global Vascular Risk Score (GVRS) are validated CHD risk models that, in addition to hard CHD events, predict stroke and other CHD outcomes. In addition to major CHD risk factors, RRS adds systemic inflammation and family history of MI as GVRS adds behavioral and anthropometric measures. This study aims to compare agreement of RRS and GVRS with FRS among Hispanic/Latino adults and to describe discordance in RRS and GVRS with FRS categories, by socio-demographic characteristics. Methods: HCHS/SOL is a population-based cohort study of Hispanics/Latinos in four US communities. The analytic sample includes 6,058 non-diabetic participants 45-74 years of age with no past history of CHD and stroke who underwent comprehensive baseline examination. 10-year hard CHD risk score was calculated; participants were categorized as low (<10%), moderate (10-<20%), and high (≥20%) risk. Kappa scores were calculated to compare agreement of RRS and GVRS with FRS. Socio-demographic characteristics of concordance and discordance were characterized overall; multinomial logistic regression models was used to examine age-sex-adjusted likelihood of in discordance by these factors. Results: Mean age of the participants was 55 (SE=0.15) years, 54.3% were women, 41% had family history of CHD, and 90% were foreign born. Overall, 4,805 (74%) had low FRS, 1,143 (24%) had moderate FRS, and 110 (2%) had high FRS. There was poor agreement between RRS and FRS (Kappa=0.16, P<0.01) and fair agreement between GVRS and FRS (Kappa=0.36, P<0.01). In age-sex-adjusted analyses, RRS and GVRS were both more likely to classify persons of moderate and high risk who are between the ages of 60-74; GVRS classified more moderate and high risk women than the FRS. RRS and GVRS discordance with FRS was not associated with nativity and length of time in US. Conclusion: Significant discordance was observed between RRS and GVRS compared to FRS. Among Hispanic/Latino adults, use of RRS or GVRS may be more inclusive in classifying older age adults and women at high 10-year CHD risk.

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Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China

10.21203/rs.2.17357/v3 ◽

2019 ◽

Author(s):

Xingyang Yi ◽

Hua Luo ◽

Ju Zhou ◽

Ming Yu ◽

Xiaorong Chen ◽

...

Keyword(s):

Risk Factors ◽

Family History ◽

High Risk ◽

Population Attributable Risk ◽

Southwestern China ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Stroke Population ◽

History Of ◽

Lack Of Exercise

Abstract Background: Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China. Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The 8 communities were selected at random, and 17413 residents aged ≥ 40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. 521 participants with incomplete questionnaires on stroke history or risk factors records were excluded. Results: A total of 16892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6% - 3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82-8.23) was significantly associated with hemorrhagic stroke. Conclusions: The prevalence of stroke and high risk stroke population was high among adults aged ≥ 40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.

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