George Howard1, Brett M Kissela2, Dawn O Kleindorfer2, Leslie A McClure2, Elsayed Z Soliman2, Suzanne E Judd2, J David Rhodes2, Mary Cushman2, Claudia S Moy2, Kara A Sands2, Virginia J Howard2. 1. From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL. ghoward@uab.edu. 2. From the Departments of Biostatistics (G.H., L.A.M., S.E.J., J.D.R.) and Epidemiology (V.J.H.), UAB School of Public Health, Birmingham, AL; Department of Neurology (B.M.K., D.O.K.), School of Medicine, University of Cincinnati, OH; Department of Epidemiology (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington; National Institute of Neurological Disorders and Stroke (C.S.M.), NIH, Bethesda, MD; and Department of Neurology (K.A.S.), UAB School of Medicine, Birmingham, AL.
Abstract
OBJECTIVES: To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs. recurrent stroke events. METHODS: Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs. recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older. RESULTS: Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86-3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70-1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. CONCLUSION: The association of age and black race differs substantially on first vs. recurrent stroke risk, with risk factors playing a similar role.
OBJECTIVES: To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs. recurrent stroke events. METHODS: Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs. recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older. RESULTS: Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction (p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86-3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70-1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants (p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. CONCLUSION: The association of age and black race differs substantially on first vs. recurrent stroke risk, with risk factors playing a similar role.
Authors: Dawn Kleindorfer; Joseph Broderick; Jane Khoury; Matthew Flaherty; Daniel Woo; Kathleen Alwell; Charles J Moomaw; Alexander Schneider; Rosie Miller; Rakesh Shukla; Brett Kissela Journal: Stroke Date: 2006-08-31 Impact factor: 7.914
Authors: Virginia J Howard; Mary Cushman; Leavonne Pulley; Camilo R Gomez; Rodney C Go; Ronald J Prineas; Andra Graham; Claudia S Moy; George Howard Journal: Neuroepidemiology Date: 2005-06-29 Impact factor: 3.282
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: 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: Karen C Albright; Lei Huang; Justin Blackburn; George Howard; Michael Mullen; Vera Bittner; Paul Muntner; Virginia Howard Journal: Neurology Date: 2018-10-03 Impact factor: 9.910
Authors: George Howard; Claudia S Moy; Virginia J Howard; Leslie A McClure; Dawn O Kleindorfer; Brett M Kissela; Suzanne E Judd; Fredrick W Unverzagt; Elsayed Z Soliman; Monika M Safford; Mary Cushman; Matthew L Flaherty; Virginia G Wadley Journal: Stroke Date: 2016-06-02 Impact factor: 7.914
Authors: P Arora; Z Agarwal; A Venkatraman; P Callas; B M Kissela; N S Jenny; S E Judd; N A Zakai; M Cushman Journal: Eur J Neurol Date: 2017-10-04 Impact factor: 6.089
Authors: Felicia C Chow; Michael R Wilson; Kunling Wu; Ronald J Ellis; Ronald J Bosch; Benjamin P Linas Journal: AIDS Date: 2018-06-01 Impact factor: 4.632
Authors: Hooman Kamel; Cenai Zhang; Dawn O Kleindorfer; Emily B Levitan; Virginia J Howard; George Howard; Elsayed Z Soliman; S Claiborne Johnston Journal: JAMA Neurol Date: 2020-05-01 Impact factor: 18.302