Randi E Foraker1, Melissa Greiner2, Mario Sims3, Katherine L Tucker4, Amytis Towfighi5, Aurelian Bidulescu6, Abigail B Shoben7, Sakima Smith8, Sameera Talegawkar9, Chad Blackshear10, Wei Wang11, Natalie Chantelle Hardy12, Emily O'Brien13. 1. Division of Epidemiology, The Ohio State University, Columbus, OH. Electronic address: rforaker@cph.osu.edu. 2. Duke Clinical Research Institute, Durham, NC. Electronic address: Melissa.Greiner@duke.edu. 3. Department of Medicine, University of Mississippi Medical Center, Birmingham, AL. Electronic address: msims2@umc.edu. 4. Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, Lowell, MA. Electronic address: Katherine_Tucker@uml.edu. 5. Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: atowfighi@dhs.lacounty.gov. 6. School of Public Health, Indiana University, Bloomington, IN. Electronic address: abidules@indiana.edu. 7. Division of Biostatistics, The Ohio State University, Columbus, OH. Electronic address: ashoben@cph.osu.edu. 8. The Ohio State University Medical Center, Columbus, OH. Electronic address: Sakima.Smith@osumc.edu. 9. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Electronic address: stalega1@jhu.edu. 10. Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS. Electronic address: cblackshear@umc.edu. 11. Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS. Electronic address: wwang@umc.edu. 12. Duke Clinical Research Institute, Durham, NC. Electronic address: chantelle.hardy@duke.edu. 13. Duke Clinical Research Institute, Durham, NC. Electronic address: emily.obrien@duke.edu.
Abstract
BACKGROUND: Evidence from existing cohort studies supports the prediction of incident coronary heart disease and stroke using 10-year cardiovascular disease (CVD) risk scores and the American Heart Association/American Stroke Association's cardiovascular health (CVH) metric. METHODS: We included all Jackson Heart Study participants with complete scoring information at the baseline study visit (2000-2004) who had no history of stroke (n = 4,140). We used Kaplan-Meier methods to calculate the cumulative incidence of stroke and used Cox models to estimate hazard ratios and 95% CIs for stroke according to CVD risk and CVH score. We compared the discrimination of the 2 models according to the Harrell c index and plotted predicted vs observed stroke risk calibration plots for each of the 2 models. RESULTS: The median age of the African American participants was 54.5 years, and 65% were female. The cumulative incidence of stroke increased across worsening categories of CVD risk and CVH. A 1-unit increase in CVD risk increased the hazard of stroke (1.07, 1.06-1.08), whereas each 1-unit increase in CVH corresponded to a decreased hazard of stroke (0.76, 0.69-0.83). As evidenced by the c statistics, the CVH model was less discriminating than the CVD risk model (0.59 [0.55-0.64] vs 0.79 [0.76-0.83]). CONCLUSIONS: Both scores were associated with incident stroke in a dose-response fashion; however, the CVD risk model was more discriminating than the CVH model. The CVH score may still be preferable for its simplicity in application to broad patient populations and public health efforts.
BACKGROUND: Evidence from existing cohort studies supports the prediction of incident coronary heart disease and stroke using 10-year cardiovascular disease (CVD) risk scores and the American Heart Association/American Stroke Association's cardiovascular health (CVH) metric. METHODS: We included all Jackson Heart Study participants with complete scoring information at the baseline study visit (2000-2004) who had no history of stroke (n = 4,140). We used Kaplan-Meier methods to calculate the cumulative incidence of stroke and used Cox models to estimate hazard ratios and 95% CIs for stroke according to CVD risk and CVH score. We compared the discrimination of the 2 models according to the Harrell c index and plotted predicted vs observed stroke risk calibration plots for each of the 2 models. RESULTS: The median age of the African American participants was 54.5 years, and 65% were female. The cumulative incidence of stroke increased across worsening categories of CVD risk and CVH. A 1-unit increase in CVD risk increased the hazard of stroke (1.07, 1.06-1.08), whereas each 1-unit increase in CVH corresponded to a decreased hazard of stroke (0.76, 0.69-0.83). As evidenced by the c statistics, the CVH model was less discriminating than the CVD risk model (0.59 [0.55-0.64] vs 0.79 [0.76-0.83]). CONCLUSIONS: Both scores were associated with incident stroke in a dose-response fashion; however, the CVD risk model was more discriminating than the CVH model. The CVH score may still be preferable for its simplicity in application to broad patient populations and public health efforts.
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