Format

Send to

Choose Destination
See comment in PubMed Commons below
Stroke. 2011 Oct;42(10):2878-82. doi: 10.1161/STROKEAHA.111.616912. Epub 2011 Aug 18.

The inclusion of stroke in risk stratification for primary prevention of vascular events: the Northern Manhattan Study.

Author information

1
Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, MPH, 1468 Madison Avenue, Annenberg 230B, New York, NY 10029, USA. mandip.dhamoon@mssm.edu

Abstract

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 individualsā‰„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.

PMID:
21852611
PMCID:
PMC3183175
DOI:
10.1161/STROKEAHA.111.616912
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center