Virginia J Howard1, Monika M Safford2, Shauntice Allen3, Suzanne E Judd4, J David Rhodes4, Dawn O Kleindorfer5, Elsayed Z Soliman6, James F Meschia7, George Howard4. 1. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: vjhoward@uab.edu. 2. Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 3. Dean's Office, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 5. Department of Neurology, University of Cincinnati, Cincinnati, Ohio. 6. Departments of Epidemiology/Prevention and Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina. 7. Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.
Abstract
BACKGROUND: Stroke symptoms in the general adult population are common and associated with stroke risk factors, lower physical and mental functioning, impaired cognitive status, and future stroke. Our objective was to determine the association of stroke symptoms with self-reported hospitalization or emergency department (ED) visit. METHODS: Lifetime history of stroke symptoms (sudden weakness, numbness, unilateral or general loss of vision, loss of ability to communicate or understand) was assessed at baseline in a national, population-based, longitudinal cohort study of 30,239 blacks and whites younger than 45 years, enrolled from 2003 to 2007. Self-reported hospitalization or ED visit and reason were collected during follow-up through March 2013. The symptom-hospitalization association was assessed by proportional hazards analysis in persons who were stroke/transient ischemic attack-free at baseline (27,126) with adjustment for sociodemographics and further adjustment for risk factors. RESULTS: One or more stroke symptoms were reported by 4758 (17.5%). After adjustment for sociodemographics, stroke symptoms were most strongly associated with greater risk of hospitalization/ED for cardiovascular disease (CVD) (hazard ratio [HR] = 1.87, 95% confidence interval [CI]: 1.78-1.96), stroke (HR = 1.69, 95% CI: 1.55-1.85), and any reason (HR = 1.39, 95% CI: 1.34-1.44). These associations remained significant and only modestly reduced after risk factor adjustment. CONCLUSIONS: Stroke symptoms are a marker for future hospitalization and ED visit not only for stroke but also for CVD in general. Findings suggest a role for stroke symptom assessment as a novel and simple approach for identifying individuals at high risk for CVD including stroke in whom preventive strategies could be implemented.
BACKGROUND:Stroke symptoms in the general adult population are common and associated with stroke risk factors, lower physical and mental functioning, impaired cognitive status, and future stroke. Our objective was to determine the association of stroke symptoms with self-reported hospitalization or emergency department (ED) visit. METHODS: Lifetime history of stroke symptoms (sudden weakness, numbness, unilateral or general loss of vision, loss of ability to communicate or understand) was assessed at baseline in a national, population-based, longitudinal cohort study of 30,239 blacks and whites younger than 45 years, enrolled from 2003 to 2007. Self-reported hospitalization or ED visit and reason were collected during follow-up through March 2013. The symptom-hospitalization association was assessed by proportional hazards analysis in persons who were stroke/transient ischemic attack-free at baseline (27,126) with adjustment for sociodemographics and further adjustment for risk factors. RESULTS: One or more stroke symptoms were reported by 4758 (17.5%). After adjustment for sociodemographics, stroke symptoms were most strongly associated with greater risk of hospitalization/ED for cardiovascular disease (CVD) (hazard ratio [HR] = 1.87, 95% confidence interval [CI]: 1.78-1.96), stroke (HR = 1.69, 95% CI: 1.55-1.85), and any reason (HR = 1.39, 95% CI: 1.34-1.44). These associations remained significant and only modestly reduced after risk factor adjustment. CONCLUSIONS:Stroke symptoms are a marker for future hospitalization and ED visit not only for stroke but also for CVD in general. Findings suggest a role for stroke symptom assessment as a novel and simple approach for identifying individuals at high risk for CVD including stroke in whom preventive strategies could be implemented.
Authors: Neil J Stone; Jennifer G Robinson; Alice H Lichtenstein; C Noel Bairey Merz; Conrad B Blum; Robert H Eckel; Anne C Goldberg; David Gordon; Daniel Levy; Donald M Lloyd-Jones; Patrick McBride; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Karol Watson; Peter W F Wilson; Karen M Eddleman; Nicole M Jarrett; Ken LaBresh; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: Beverly G Windham; Michael E Griswold; Dean Shibata; Alan Penman; Diane J Catellier; Thomas H Mosley Journal: Stroke Date: 2012-03-01 Impact factor: 7.914
Authors: Cheryl Bushnell; Louise D McCullough; Issam A Awad; Monique V Chireau; Wende N Fedder; Karen L Furie; Virginia J Howard; Judith H Lichtman; Lynda D Lisabeth; Ileana L Piña; Mathew J Reeves; Kathryn M Rexrode; Gustavo Saposnik; Vineeta Singh; Amytis Towfighi; Viola Vaccarino; Matthew R Walters Journal: Stroke Date: 2014-02-06 Impact factor: 7.914
Authors: Paul A James; Suzanne Oparil; Barry L Carter; William C Cushman; Cheryl Dennison-Himmelfarb; Joel Handler; Daniel T Lackland; Michael L LeFevre; Thomas D MacKenzie; Olugbenga Ogedegbe; Sidney C Smith; Laura P Svetkey; Sandra J Taler; Raymond R Townsend; Jackson T Wright; Andrew S Narva; Eduardo Ortiz Journal: JAMA Date: 2014-02-05 Impact factor: 56.272
Authors: Larry B Goldstein; Cheryl D Bushnell; Robert J Adams; Lawrence J Appel; Lynne T Braun; Seemant Chaturvedi; Mark A Creager; Antonio Culebras; Robert H Eckel; Robert G Hart; Judith A Hinchey; Virginia J Howard; Edward C Jauch; Steven R Levine; James F Meschia; Wesley S Moore; J V Ian Nixon; Thomas A Pearson Journal: Stroke Date: 2010-12-02 Impact factor: 7.914
Authors: Dawn Kleindorfer; Suzanne Judd; Virginia J Howard; Leslie McClure; Monika M Safford; Mary Cushman; David Rhodes; George Howard Journal: Stroke Date: 2011-09-15 Impact factor: 7.914
Authors: Suzanne E Judd; Dawn O Kleindorfer; Leslie A McClure; J David Rhodes; George Howard; Mary Cushman; Virginia J Howard Journal: Stroke Date: 2012-12-11 Impact factor: 7.914
Authors: Virginia J Howard; Dawn O Kleindorfer; Suzanne E Judd; Leslie A McClure; Monika M Safford; J David Rhodes; Mary Cushman; Claudia S Moy; Elsayed Z Soliman; Brett M Kissela; George Howard Journal: Ann Neurol Date: 2011-03-17 Impact factor: 10.422
Authors: D Leann Long; Boyi Guo; Leslie A McClure; Byron C Jaeger; Stephanie E Tison; George Howard; Suzanne E Judd; Virginia J Howard; Timothy B Plante; Neil A Zakai; Insu Koh; Katharine L Cheung; Mary Cushman Journal: Ann Epidemiol Date: 2021-11-03 Impact factor: 3.797