The inclusion of stroke in risk stratification for primary prevention of vascular events: The Northern manhattan study

Mandip S. Dhamoon, Yeseon Park Moon, Myunghee C. Paik, Ralph L Sacco, Mitchell S V Elkind

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 languageEnglish
Pages (from-to)2878-2882
Number of pages5
JournalStroke
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2011

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Primary Prevention
Blood Vessels
Stroke
Coronary Disease
Myocardial Infarction
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Urban Population
Vascular Diseases
Hispanic Americans
Ethnic Groups

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 journalArticle

Dhamoon, Mandip S. ; Moon, Yeseon Park ; Paik, Myunghee C. ; Sacco, Ralph L ; Elkind, Mitchell S V. / The inclusion of stroke in risk stratification for primary prevention of vascular events : The Northern manhattan study. In: Stroke. 2011 ; Vol. 42, No. 10. pp. 2878-2882.
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