Abstract
Background and Purpose-The Framingham coronary heart disease (CHD) risk score estimates 10-year risk of myocardial infarction (MI) and CHD death. Because preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate. We compared 10-year risk of (1) MI or CHD death; and (2) stroke, MI, or CHD death among individuals free of vascular disease. Methods-The Northern Manhattan Study contains a prospective, population-based study of stroke-and CHD-free individuals 40 years of age followed for a median of 10 years for vascular events. Framingham coronary heart disease risk score was calculated for each individual and for each category of predicted risk, Kaplan-Meier observed 10-year cumulative probabilities were calculated for (1) MI or CHD death; and (2) stroke, MI, or CHD death. The cumulative probability of (1) was subtracted from (2), and 95% CIs for the difference were obtained with 1000 bootstrap samples. Using stratified analyses by race-ethnicity, we compared risk differences among race-ethnic groups. RESULTS-: Among 2613 participants (53% Hispanic, 25% non-Hispanic black, and 20% non-Hispanic white), observed 10-year risk of MI or CHD death was 14.20%. With stroke in the outcome, observed risk was 21.98% (absolute risk difference, 7.78%; 95% CI, 5.86% to 9.75%). The absolute risk difference among blacks was significantly larger than among whites (P=0.01). Conclusions-In this multiethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% relative increase in estimated risk and crossing of the absolute risk threshold (>20% over 10 years) considered for preventive treatments such as statins.
| Original language | English |
|---|---|
| Pages (from-to) | 2878-2882 |
| Number of pages | 5 |
| Journal | Stroke |
| Volume | 42 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2011 |
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Keywords
- epidemiology
- risk factors
- stroke management
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Clinical Neurology
- Advanced and Specialized Nursing
Cite this
The inclusion of stroke in risk stratification for primary prevention of vascular events : The Northern manhattan study. / Dhamoon, Mandip S.; Moon, Yeseon Park; Paik, Myunghee C.; Sacco, Ralph L; Elkind, Mitchell S V.
In: Stroke, Vol. 42, No. 10, 01.10.2011, p. 2878-2882.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The inclusion of stroke in risk stratification for primary prevention of vascular events
T2 - The Northern manhattan study
AU - Dhamoon, Mandip S.
AU - Moon, Yeseon Park
AU - Paik, Myunghee C.
AU - Sacco, Ralph L
AU - Elkind, Mitchell S V
PY - 2011/10/1
Y1 - 2011/10/1
N2 - Background and Purpose-The Framingham coronary heart disease (CHD) risk score estimates 10-year risk of myocardial infarction (MI) and CHD death. Because preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate. We compared 10-year risk of (1) MI or CHD death; and (2) stroke, MI, or CHD death among individuals free of vascular disease. Methods-The Northern Manhattan Study contains a prospective, population-based study of stroke-and CHD-free individuals 40 years of age followed for a median of 10 years for vascular events. Framingham coronary heart disease risk score was calculated for each individual and for each category of predicted risk, Kaplan-Meier observed 10-year cumulative probabilities were calculated for (1) MI or CHD death; and (2) stroke, MI, or CHD death. The cumulative probability of (1) was subtracted from (2), and 95% CIs for the difference were obtained with 1000 bootstrap samples. Using stratified analyses by race-ethnicity, we compared risk differences among race-ethnic groups. RESULTS-: Among 2613 participants (53% Hispanic, 25% non-Hispanic black, and 20% non-Hispanic white), observed 10-year risk of MI or CHD death was 14.20%. With stroke in the outcome, observed risk was 21.98% (absolute risk difference, 7.78%; 95% CI, 5.86% to 9.75%). The absolute risk difference among blacks was significantly larger than among whites (P=0.01). Conclusions-In this multiethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% relative increase in estimated risk and crossing of the absolute risk threshold (>20% over 10 years) considered for preventive treatments such as statins.
AB - Background and Purpose-The Framingham coronary heart disease (CHD) risk score estimates 10-year risk of myocardial infarction (MI) and CHD death. Because preventive approaches to CHD and stroke are similar, a composite outcome may be more appropriate. We compared 10-year risk of (1) MI or CHD death; and (2) stroke, MI, or CHD death among individuals free of vascular disease. Methods-The Northern Manhattan Study contains a prospective, population-based study of stroke-and CHD-free individuals 40 years of age followed for a median of 10 years for vascular events. Framingham coronary heart disease risk score was calculated for each individual and for each category of predicted risk, Kaplan-Meier observed 10-year cumulative probabilities were calculated for (1) MI or CHD death; and (2) stroke, MI, or CHD death. The cumulative probability of (1) was subtracted from (2), and 95% CIs for the difference were obtained with 1000 bootstrap samples. Using stratified analyses by race-ethnicity, we compared risk differences among race-ethnic groups. RESULTS-: Among 2613 participants (53% Hispanic, 25% non-Hispanic black, and 20% non-Hispanic white), observed 10-year risk of MI or CHD death was 14.20%. With stroke in the outcome, observed risk was 21.98% (absolute risk difference, 7.78%; 95% CI, 5.86% to 9.75%). The absolute risk difference among blacks was significantly larger than among whites (P=0.01). Conclusions-In this multiethnic urban population, adding stroke to the risk stratification outcome cluster resulted in a 55% relative increase in estimated risk and crossing of the absolute risk threshold (>20% over 10 years) considered for preventive treatments such as statins.
KW - epidemiology
KW - risk factors
KW - stroke management
UR - http://www.scopus.com/inward/record.url?scp=80053338172&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80053338172&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.111.616912
DO - 10.1161/STROKEAHA.111.616912
M3 - Article
C2 - 21852611
AN - SCOPUS:80053338172
VL - 42
SP - 2878
EP - 2882
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 10
ER -