BACKGROUND AND PURPOSE: This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. METHODS: We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of stroke or MI. Baseline data comprised questionnaire responses, clinical measurements, and comorbidity. RESULTS: After a median of 6 years (interquartile range, 5.2-7.2) of follow-up, the overall rate of stroke/MI was 2.61 (95% CI, 2.42-2.81) per 100 person-years. Among major traditional risk prediction variables, only age and smoking were significantly associated with stroke/MI. In our final multivariate model, the independent significant predictors of stroke/MI were age (HR for age older than 85, 3.18; 95% CI, 2.05-4.93), diastolic blood pressure <70 mm Hg (Hazard ratio [HR], 1.45; 95% CI, 1.18-1.78), high-sensitivity C-reactive protein >3 mg/L (HR, 1.29; 95% CI, 1.05-1.59), homocysteine >15 umol/L (HR, 1.35; 95% CI, 1.09-1.67), waist-to-hip ratio >1 (HR, 1.47; 95% CI, 1.20-1.18), and fair or poor self-reported health (HR, 1.52; 95% CI, 1.19-1.94). A new risk model incorporating these variables performed well compared with the Framingham risk equation (Harrell C of 0.660 versus C of 0.620; integrated discrimination improvement of 1.85%; z=4.95; P<0.001; net reclassification index of 0.08; z=2.0; P=0.023). The model was used to develop an 8- point clinical risk score comprising the independent predictors of stroke/MI among this population. CONCLUSIONS: Traditional vascular risk factors did not optimally predict stroke/MI among this cohort of community-dwelling older men. We have constructed a new risk score that requires validation in other data sets.
BACKGROUND AND PURPOSE: This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. METHODS: We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of stroke or MI. Baseline data comprised questionnaire responses, clinical measurements, and comorbidity. RESULTS: After a median of 6 years (interquartile range, 5.2-7.2) of follow-up, the overall rate of stroke/MI was 2.61 (95% CI, 2.42-2.81) per 100 person-years. Among major traditional risk prediction variables, only age and smoking were significantly associated with stroke/MI. In our final multivariate model, the independent significant predictors of stroke/MI were age (HR for age older than 85, 3.18; 95% CI, 2.05-4.93), diastolic blood pressure <70 mm Hg (Hazard ratio [HR], 1.45; 95% CI, 1.18-1.78), high-sensitivity C-reactive protein >3 mg/L (HR, 1.29; 95% CI, 1.05-1.59), homocysteine >15 umol/L (HR, 1.35; 95% CI, 1.09-1.67), waist-to-hip ratio >1 (HR, 1.47; 95% CI, 1.20-1.18), and fair or poor self-reported health (HR, 1.52; 95% CI, 1.19-1.94). A new risk model incorporating these variables performed well compared with the Framingham risk equation (Harrell C of 0.660 versus C of 0.620; integrated discrimination improvement of 1.85%; z=4.95; P<0.001; net reclassification index of 0.08; z=2.0; P=0.023). The model was used to develop an 8- point clinical risk score comprising the independent predictors of stroke/MI among this population. CONCLUSIONS: Traditional vascular risk factors did not optimally predict stroke/MI among this cohort of community-dwelling older men. We have constructed a new risk score that requires validation in other data sets.
Authors: Nancy R Cook; Nina P Paynter; Charles B Eaton; JoAnn E Manson; Lisa W Martin; Jennifer G Robinson; Jacques E Rossouw; Sylvia Wassertheil-Smoller; Paul M Ridker Journal: Circulation Date: 2012-03-07 Impact factor: 29.690
Authors: Ute Mons; Aysel Müezzinler; Carolin Gellert; Ben Schöttker; Christian C Abnet; Martin Bobak; Lisette de Groot; Neal D Freedman; Eugène Jansen; Frank Kee; Daan Kromhout; Kari Kuulasmaa; Tiina Laatikainen; Mark G O'Doherty; Bas Bueno-de-Mesquita; Philippos Orfanos; Annette Peters; Yvonne T van der Schouw; Tom Wilsgaard; Alicja Wolk; Antonia Trichopoulou; Paolo Boffetta; Hermann Brenner Journal: BMJ Date: 2015-04-20
Authors: Emma van Bussel; Leony Reurich; Jeannette Pols; Edo Richard; Eric Moll van Charante; Suzanne Ligthart Journal: BMJ Open Date: 2019-08-18 Impact factor: 2.692