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.
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.
Authors: Thomas A Pearson; Steven N Blair; Stephen R Daniels; Robert H Eckel; Joan M Fair; Stephen P Fortmann; Barry A Franklin; Larry B Goldstein; Philip Greenland; Scott M Grundy; Yuling Hong; Nancy Houston Miller; Ronald M Lauer; Ira S Ockene; Ralph L Sacco; James F Sallis; Sidney C Smith; Neil J Stone; Kathryn A Taubert Journal: Circulation Date: 2002-07-16 Impact factor: 29.690
Authors: W D Rosamond; A R Folsom; L E Chambless; C H Wang; P G McGovern; G Howard; L S Copper; E Shahar Journal: Stroke Date: 1999-04 Impact factor: 7.914
Authors: Larry B Goldstein; Robert Adams; Mark J Alberts; Lawrence J Appel; Lawrence M Brass; Cheryl D Bushnell; Antonio Culebras; Thomas J Degraba; Philip B Gorelick; John R Guyton; Robert G Hart; George Howard; Margaret Kelly-Hayes; J V Ian Nixon; Ralph L Sacco Journal: Stroke Date: 2006-05-04 Impact factor: 7.914
Authors: D S Echt; P R Liebson; L B Mitchell; R W Peters; D Obias-Manno; A H Barker; D Arensberg; A Baker; L Friedman; H L Greene Journal: N Engl J Med Date: 1991-03-21 Impact factor: 91.245
Authors: E J Schaefer; S Lamon-Fava; J L Jenner; J R McNamara; J M Ordovas; C E Davis; J M Abolafia; K Lippel; R I Levy Journal: JAMA Date: 1994-04-06 Impact factor: 56.272