Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Judd, Suzanne E.; Kleindorfer, Dawn; McClure, Leslie A.; Rhodes, J.; Howard, George; Cushman, Mary; Howard, Virginia J.

doi:10.1161/strokeaha.112.675033

Cited by 44 publications

(48 citation statements)

References 27 publications

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“…Most notably, while we reviewed medical records on suspected stroke events occurring during follow-up, we had to rely on self-reported stroke events occurring before participants were enrolled in study. However, these self-reported strokes at baseline have previously been found to be a reliable predictor of recurrent events, 18 a relationship confirmed herein. Perhaps more important, the specificity of self-reported stroke has been generally reported to be above 95% (and the sensitivity is generally above 80%), [19][20][21][22][23] suggesting that few individuals falsely self-reported stroke.…”

Section: Resultssupporting

confidence: 82%

Differences in the role of black race and stroke risk factors for first vs recurrent stroke

et al. 2016

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Objectives: To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs recurrent stroke events.Methods: Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older.Results: Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p 5 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86-3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio 5 0.91; 95% confidence interval: 0.70-1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p . 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. Conclusion:The association of age and black race differs substantially on first vs recurrent stroke risk, with risk factors playing a similar role. Risk factors for first stroke have been well studied, 1 providing a framework for primary stroke prevention. Multivariable risk functions developed in the Framingham 2 and Cardiovascular Health Study 3 cohorts have identified age, sex, hypertension, diabetes, cigarette smoking, left ventricular hypertrophy, atrial fibrillation, and heart disease as predictors of incident stroke in a stroke-free population. A limitation of those studies was their inability to address the role of race (black race specifically) as a risk factor for stroke; however, there are substantial differences in stroke incidence between black and white persons, with incident stroke in black persons approximately 3 times higher between the ages of 45 and 65 years, but with disparities attenuating by age 85. [4][5][6][7][8] While substantial data document the risk factors for first stroke, there are fewer data establishing the risk factors for recurrent stroke (that is, risk factors for a subsequent stroke in a population with a previous stroke). The

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Section: Resultssupporting

confidence: 82%

Differences in the role of black race and stroke risk factors for first vs recurrent stroke

et al. 2016

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“…The differences between developed and undeveloped countries are related, probably, to the management of risk factors such as hypertension, diabetes, and smoking 20,21 . Liu et al 15 revealed a decrease of 21.4% in the incidence of stroke in 4 years in China between 1992 and 1995.…”

Section: Discussionmentioning

confidence: 99%

Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia

Lopes

Sanchis

Medeiros

et al. 2016

Rev. bras. epidemiol.

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Objective:The study evaluated the trend of hospitalization for ischemic stroke (HIS) and its hospital mortality in Brazil over the last 15 years as well as the impact of the Hiperdia program in this scenario. Methods: An ecological study was designed with analytical approach and data collected in the Hospital Admission System on episodes of stroke, over the years 1998 to 2012. All data were stratified by sex and age, creating an indicator for HIS and proportion of hospital mortality. To estimate the trend of the data a polynomial curve fitting was created; and the Generalized Linear Model was applied to investigate the impact of Hiperdia on the endpoint HIS and hospital mortality. We adopted a 5% significance level to minimize an error type I. Results: We observed a reduction of HIS from 37.57/10 5 inhabitants in 1998 to 2001 to 10.33/10 5 inhabitants in 2002 to 2005, declining 73.64%. The reduction occurred in both sexes and for all age groups. The mortality rate of ischemic stroke also declined in Brazil since 2002, in both men and women, therefore in less than 3%; and only in the groups aged between 0 and 14 and above 80 years, we did not detect trend. Conclusion: Therefore, the decline of HIS temporally coincided with the implementation of Hiperdia in 2002 and this trend continues today.

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“…Also, the authors intended to recruit 50% blacks in their study but could include only 38.6% blacks. 1 The authors did not discuss the reasons of lower recruitment of blacks in their study. Understanding the reasons for a lower recruitment rate is important to improve the recruitment of this community in the future stroke trials.…”

Section: To the Editormentioning

confidence: 94%

“…We read with great interest the recent article published by Judd et al 1 in which a study on risk of future stroke recurrence was described. The authors specifically studied different types of baseline ischemic strokes influencing US patients' future risk of ischemic stroke in a sample from the south eastern sector of the United States, also known as the stroke belt.…”

Section: To the Editormentioning

confidence: 99%

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Letter by Mittal and McCormick Regarding Article, “Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study”

Mittal

McCormick

2013

Stroke

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Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Cited by 44 publications

References 27 publications

Differences in the role of black race and stroke risk factors for first vs recurrent stroke

Differences in the role of black race and stroke risk factors for first vs recurrent stroke

Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia

Letter by Mittal and McCormick Regarding Article, “Self-Report of Stroke, Transient Ischemic Attack, or Stroke Symptoms and Risk of Future Stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study”

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