Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the Northern Manhattan study

Joshua Z. Willey, Yeseon Park Moon, Emily Kahn, Carlos J. Rodriguez, Tatjana Rundek, Ken Cheung, Ralph L Sacco, Mitchell S V Elkind

Research output: Contribution to journalArticle

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Abstract

Background-Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. Methods and Results-The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non-Hispanic whites (2.6%; 95% CI, -33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (-0.3%; 95% CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/raceethnicity. Conclusions-HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.

Original languageEnglish (US)
Article numbere001106
JournalJournal of the American Heart Association
Volume3
Issue number5
StatePublished - 2014

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Cardiovascular Diseases
Myocardial Infarction
Confidence Intervals
Hypertension
Stroke
Population
Blood Vessels
Hispanic Americans
Urban Population
Resource Allocation
Health Promotion
Proportional Hazards Models
Cohort Studies
Public Health
Prospective Studies
Incidence

Keywords

  • Aging
  • Attributable risk
  • Diabetes
  • Hypertension
  • Stroke
  • Vascular death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the Northern Manhattan study. / Willey, Joshua Z.; Moon, Yeseon Park; Kahn, Emily; Rodriguez, Carlos J.; Rundek, Tatjana; Cheung, Ken; Sacco, Ralph L; Elkind, Mitchell S V.

In: Journal of the American Heart Association, Vol. 3, No. 5, e001106, 2014.

Research output: Contribution to journalArticle

Willey, Joshua Z. ; Moon, Yeseon Park ; Kahn, Emily ; Rodriguez, Carlos J. ; Rundek, Tatjana ; Cheung, Ken ; Sacco, Ralph L ; Elkind, Mitchell S V. / Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the Northern Manhattan study. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 5.
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abstract = "Background-Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. Methods and Results-The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95{\%} confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3{\%} (95{\%} CI, 13.2 to 35.4) for VE and 29.9{\%} (95{\%} CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7{\%} (95{\%} CI, 8.2 to 17.2) for VE and 19.5{\%} (95{\%} CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6{\%}; 95{\%} CI, 29.2 to 71.9) than non-Hispanic whites (2.6{\%}; 95{\%} CI, -33.2 to 38.6) and in those <80 years of age (35.6{\%}; 95{\%} CI, 18.9 to 52.3) than in those ≥80 (-0.3{\%}; 95{\%} CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6{\%} among those <80 years of age (95{\%} CI, 15.7 to 31.5) and 2.3{\%} among those ≥80 (95{\%} CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/raceethnicity. Conclusions-HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.",
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T1 - Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the Northern Manhattan study

AU - Willey, Joshua Z.

AU - Moon, Yeseon Park

AU - Kahn, Emily

AU - Rodriguez, Carlos J.

AU - Rundek, Tatjana

AU - Cheung, Ken

AU - Sacco, Ralph L

AU - Elkind, Mitchell S V

PY - 2014

Y1 - 2014

N2 - Background-Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. Methods and Results-The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non-Hispanic whites (2.6%; 95% CI, -33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (-0.3%; 95% CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/raceethnicity. Conclusions-HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.

AB - Background-Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. Methods and Results-The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non-Hispanic whites (2.6%; 95% CI, -33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (-0.3%; 95% CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/raceethnicity. Conclusions-HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.

KW - Aging

KW - Attributable risk

KW - Diabetes

KW - Hypertension

KW - Stroke

KW - Vascular death

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