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  • 1
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    Effects of intensive versus standard blood pressure control on domain-specific cognitive function: a substudy of the SPRINT randomised controlled trial
    Elsevier BV ; 2020
    In:  The Lancet Neurology Vol. 19, No. 11 ( 2020-11), p. 899-907
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 19, No. 11 ( 2020-11), p. 899-907
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(20)30319-7
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 2
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    Abstract P091: Early Life Stressors and Adult Cardiovascular Health in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation Vol. 137, No. suppl_1 ( 2018-03-20)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 137, No. suppl_1 ( 2018-03-20)
    Abstract: Introduction: Prior research suggests early life stressors (ELS) influence development of cardiovascular (CV) risk over the lifecourse, but few national studies have evaluated this. We examined the association of ELS with adult CV defined by Life’s Simple 7 (LS7) score within a national US population-based cohort. Methods: We used data on 7,469 REGARDS participants (black and white adults, aged 〉 45 in 2003-2007), with clinical and behavioral risk factor data from questionnaires and direct measurement. Levels of LS7 components (blood pressure, total cholesterol, fasting glucose, physical activity, smoking, diet, body mass index) were coded as poor (0 points), intermediate (1 point) or ideal (2 points); the primary outcome, LS7 score, was the sum of the components. In 2012-2013, 7 ELS (death of parent, parents separated/divorced, family serious illness, witnessed family violence, family substance abuse, parent’s loss of job and parent incarcerated) were retrospectively assessed by mail questionnaire to active participants. Linear regression was used to characterize the relationship between each ELS and LS7 after adjustment for demographics and region of birth. Mediation by adult income and education was examined. Results: ELS were common, ranging from 3% for parent incarcerated to 29% for family serious illness. Lower LS7 was associated with each ELS, with significant association with witnessing family violence (-0.15; 95% CI: -0.29 to -0.02) (see figure.) Additional adjustment for adult education partially attenuated the effect estimates for witnessed family violence by 20.6% (95% CI: 2.0%, 39.1%); adjustment for adult income and education mediated the non-significant estimates for parental death, family illness and separation/divorce. Conclusions: Exposure to ELS was associated worse adult cardiovascular health; these associations were partially but not fully mediated by adult socioeconomic status. Further work is needed in categorization of ELS and examination of pathways underlying the associations.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.137.suppl_1.p091
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1466401-X
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  • 3
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    Mild cognitive impairment and transitions in cognitive status in the Systolic Blood Pressure Intervention Trial (SPRINT)
    Wiley ; 2021
    In:  Alzheimer's & Dementia Vol. 17, No. S10 ( 2021-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated a significant reduction in the occurrence of mild cognitive impairment (MCI) for adults with hypertension randomly assigned to intensive systolic blood pressure (SBP) lowering and a similar but non‐significant effect on incidence of dementia.. Given that individuals with MCI are at greater risk of progressing to dementia, an open question from the trial is the frequency of progression in cognitive status subsequent to an adjudication of MCI, and whether this associates with intensive SBP lowering. Method Randomized trial of community‐dwelling adults (≥50 years) with hypertension. Participants were randomized to a SBP goal of 〈 120 mm Hg (intensive treatment; n=4678) or 〈 140 mm Hg (standard treatment; n=4683). Adjudication of MCI or dementia followed standardized procedures by a panel of expert clinicians. Multistate survival models were used to examine transitions in cognitive status between normal cognitive function, MCI, and dementia, accounting for the competing risk of death. Result Among 9361 randomized participants (mean age, 67.9 years; 3332 women [35.6%]), 91.5% completed at least 1 follow‐up cognitive assessment over a median follow‐up of 5.1 years. Based on multistate modeling, from a state of normal cognitive function, the risk of transitioning to dementia in the next 2 years was 1.1% [95% Confidence Interval (CI): 1.0% to 1.3%] ), with 2.3% [95% CI: 2.1% to 2.5%] of participants dying over that same interval. Subsequent to an adjudication of MCI, the probability of progressing to dementia in the next 2 years increased to 6.4% [95% CI: 5.3% to 7.8%] , with the risk of death increasing to 8.2% [95% CI: 6.9% to 9.7%]. We did not observe any significant associations between treatment groups and transition risk within the multistate model, though power for these analyses was likely limited given the focus on complex transitions between multiple outcomes. Conclusion An adjudication of MCI in SPRINT was associated with an increased risk of progression to dementia and death in the following 2 years, highlighting the relevance of MCI as an outcome both within SPRINT and for future prevention trials of cognitive impairment.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v17.S10
    DOI: 10.1002/alz.053865
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2201940-6
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  • 4
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    Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials
    SAGE Publications ; 2017
    In:  International Journal of Stroke Vol. 12, No. 7 ( 2017-10), p. 770-778
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 12, No. 7 ( 2017-10), p. 770-778
    Abstract: Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus intensive medical therapy versus intensive medical therapy alone. The risk factor targets of centrally directed intensive medical therapy are LDL cholesterol 〈 70 mg/dl and systolic blood pressure 〈 140 mmHg. Study outcomes The primary outcome is the composite of stroke and death within 44 days following randomization and stroke ipsilateral to the target vessel thereafter, up to four years. Change in cognition and differences in major and minor stroke are secondary outcomes. Sample size Enrollment of 1240 patients in each trial provides 85% power to detect a treatment difference if the event rate in the intensive medical therapy alone arm is 4.8% higher or 2.8% lower than an anticipated 3.6% rate in the revascularization arm. Discussion Management of asymptomatic carotid stenosis requires contemporary randomized trials to address whether carotid endarterectomy or carotid stenting plus intensive medical therapy is superior in preventing stroke beyond intensive medical therapy alone. Whether carotid endarterectomy or carotid stenting has favorable effects on cognition will also be tested. Trial registration United States National Institutes of Health Clinicaltrials.gov NCT02089217
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493017706238
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2211666-7
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  • 5
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    An Investigation of Selection Bias in Estimating Racial Disparity in Stroke Risk Factors
    Oxford University Press (OUP) ; 2019
    In:  American Journal of Epidemiology Vol. 188, No. 3 ( 2019-03-01), p. 587-597
    Details
    In: American Journal of Epidemiology, Oxford University Press (OUP), Vol. 188, No. 3 ( 2019-03-01), p. 587-597
    Type of Medium: Online Resource
    ISSN: 0002-9262 , 1476-6256
    URL: Article
    DOI: 10.1093/aje/kwy253
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2030043-8
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  • 6
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    The Association between the Montreal Cognitive Assessment and Functional Activity Questionnaire in the Systolic Blood Pressure Intervention Trial (SPRINT)
    Oxford University Press (OUP) ; 2019
    In:  Archives of Clinical Neuropsychology Vol. 34, No. 6 ( 2019-08-28), p. 814-824
    Details
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), Vol. 34, No. 6 ( 2019-08-28), p. 814-824
    Abstract: To examine the association of global cognitive function assessed via the Montreal Cognitive Assessment (MoCA) and deficiencies in instrumental activities of daily living (IADL) on the Functional Activity Questionnaire (FAQ) in hypertensive older adults in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods In cross-sectional analysis, 9,296 SPRINT participants completed the MoCA at baseline. The FAQ was obtained from 2,705 informants for SPRINT participants scoring 〈 21 or 〈 22 on the MoCA, depending on education. FAQ severity ranged from no dysfunction (Score = 0) to moderate/severe dysfunction (Score = 5+). Results Participants who triggered FAQ administration were older, less educated, and more likely to be Black or Hispanic (p 〈 0.001). Sixty-one percent (n = 1,661) of participants’ informants reported no functional difficulties in IADLs. An informant report, however, of any difficulty on the FAQ was associated with lower MoCA scores after controlling for age, sex, race/ethnicity, and education (p 〈 0.05). Partial proportional odds regression indicates that participants scoring lower on the MoCA (in the 10th to 〈 25th, fifth to 〈 10th, and 〈 fifth percentiles) had higher adjusted odds of their informant indicating dysfunction on the FAQ, relative to participants scoring at or above the 25th percentile on the MoCA (p 〈 0.001). Conclusions While lower global cognitive function was strongly associated with IADL deficits on FAQ, informants indicated no functional difficulties for the majority of SPRINT participants, despite low MoCA scores. These findings can help with designing future studies which aim to detect mild cognitive impairment and/or dementia in large, community-dwelling populations.
    Type of Medium: Online Resource
    ISSN: 1873-5843
    URL: Article
    DOI: 10.1093/arclin/acy094
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2003528-7
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  • 7
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    Vitamin D deficiency and incident stroke risk in community-living black and white adults
    SAGE Publications ; 2016
    In:  International Journal of Stroke Vol. 11, No. 1 ( 2016-01), p. 93-102
    Details
    In: International Journal of Stroke, SAGE Publications, Vol. 11, No. 1 ( 2016-01), p. 93-102
    Abstract: Black individuals are at greater risk of stroke and vitamin D deficiency than white individuals. Epidemiologic studies have shown that low 25-hydroxyvitamin D concentrations are associated with increased risk of stroke, but these studies had limited representation of black individuals. Methods We examined the association of 25-hydroxyvitamin D with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults ≥45 years of age. Using a case–cohort study design, plasma 25-hydroxyvitamin D was measured in 610 participants who developed incident stroke (cases) and in 937 stroke-free individuals from a stratified cohort random sample of REGARDS participants (comparison cohort). Results In multivariable models adjusted for socio-demographic factors, co-morbidities and laboratory values including parathyroid hormone, lower 25-hydroxyvitamin D concentrations were associated with higher risk of stroke (25-hydroxyvitamin D 〉 30 ng/mL reference; 25-hydroxyvitamin D concentrations 20–30 ng/mL, hazard ratio 1.33, 95% confidence interval (95% CI) 0.89,1.96; 25-hydroxyvitamin D 〈 20 ng/mL, hazard ratio 1.85, 95% CI 1.17, 2.93). There were no statistically significant differences in the association of lower 25-hydroxyvitamin D with higher risk of stroke in black vs. white participants in fully adjusted models (hazard ratio comparing lowest vs. highest 25-hydroxyvitamin D category 2.62, 95% CI 1.18, 5.83 in blacks vs. 1.64, 95% CI 0.83, 3.24 in whites, P interaction  = 0.82). The associations were qualitatively unchanged when restricted to ischemic or hemorrhagic stroke subtypes or when using race-specific cut-offs for 25-hydroxyvitamin D categories. Conclusions Vitamin D deficiency is a risk factor for incident stroke and the strength of this association does not appear to differ by race.
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    URL: Article
    DOI: 10.1177/1747493015607515
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 8
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    Abstract WP482: Early Life Exposure to the Stroke Belt and Later Life Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Introduction: Incidence of cognitive impairment is higher for residents of the Stroke Belt (SB) compared to those living outside it, but the importance of timing of SB residence is unclear. Methods: Participants were aged 45+ yrs, and enrolled in 2003-2007 in REGARDS. Cognition was assessed annually, by telephone, using the Six-Item Screener (SIS) in 11,488 black or white stroke-free participants currently living in the SB, and 8,949 currently living outside of the SB. Incident cognitive impairment was defined as SIS score of 〈 4 at last assessment among participants with initial SIS 〉 4. Exposures were defined as SB residence all years, some years, or no years of childhood (ages 0-18) and early adulthood (ages 19-30). Demographic adjusted logistic regression models were stratified by SB residence at enrollment, and were used to estimate the demographic-adjusted odds of incident cognitive impairment. Results: Among those currently residing in the SB, childhood residence outside the SB for some (OR = 0.82; 95% CI: 0.68 - 0.99) or all (OR = 0.76; 95% CI: 0.65 - 0.90) of the time predicted lower odds of incident cognitive impairment. Similarly, early adulthood residence outside the SB for some (OR = 0.86; 95% CI: 0.74 - 0.98) or all (OR = 0.70; 95% CI: 0.58 - 0.84) of the time predicted lower incident cognitive impairment. Conversely, for those currently living outside the SB, the risk of incident cognitive impairment was higher for those who had spent their entire early adulthood in the SB (OR = 1.51; 95% CI: 1.01 - 2.57), with non-significant increased risk for childhood exposure or some early adulthood exposure to the SB (table). Conclusions: These findings suggest that early residence in the SB during childhood or early adulthood increases the risk of cognitive impairment regardless of place of residence in later adulthood. Further research is needed to determine the characteristics of early SB life that are linked to later adult cognitive impairment.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP482
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Abstract 3027: Report of Stroke Symptoms in the Absence of Stroke Predicts Incident Cognitive Impairment
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Introduction: Stroke and vascular risk factors are recognized as important markers of increased risk of cognitive impairment. Experience of stroke-like symptoms and/or transient ischemic attack (SS/TIA) are suspected to represent another independent marker of risk for cognitive impairment. Methods: We assessed these relationships in REGARDS, a national longitudinal cohort study following over 30,000 black and white participants aged 45 and older from the 48 contiguous states. Cognitive function is assessed by several scales, including the Six-Item Screener (SIS), conducted by telephone at baseline and annually during follow-up. After excluding those who were impaired at first assessment, 23,830 participants (mean baseline age 64.2) were stroke free at baseline and had at least two cognitive function assessments (11,096 with two to four, and 12,734 with more than four). Observation time was censored after a suspected stroke during follow-up (censoring 1439 assessments in 515 participants). SS/TIA were assessed using the Questionnaire for Verifying Stroke-Free Status. The association between report of SS/TIA and subsequent impairment was assessed using logistic regression, both univariately and after adjustment for a variety of risk factors. In addition, the role of the Framingham Stroke Risk (FSR) in these relationships was examined. Incident impairment was characterized as a score of 4 or fewer on the most recently assessed SIS. Models were fitted separately for white and black subjects to evaluate race-specific effects. Results: Among blacks, the presence of any incident SS/TIA was associated with 1.66 (95% CI: 1.45, 1.89) times the likelihood of impairment in an unadjusted model, compared to those with no SS/TIA, which was slightly attenuated to 1.41 (95% CI: 1.23, 1.62) in a model incorporating gender, income, region and education. Among whites, the unadjusted OR was 2.08 (95% CI: 1.81, 2.39), with an adjusted OR of 1.85 (95% CI: 1.61, 2.13). The association between SS/TIA differed by FSRF, with a stronger association between SS/TIA and impairment among those with lower FSR, both for blacks and whites. Discussion: In an initially stroke-free cohort and with censoring of incident stroke cases in the follow-up, report of SS/TIA was strongly related to increased risk of cognitive impairment. The stronger association between self-report of SS/TIA and incident cognitive impairment among those with lower FSR score suggests these symptoms may reflect risk factors for cognitive impairment not captured in the FSR. This effect was larger in whites, suggesting differential sensitivity or exposure to this risk.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A3027
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 10
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    Abstract 032: Rural Versus Urban Living and Incident Cognitive Impairment in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS)
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation Vol. 139, No. Suppl_1 ( 2019-03-05)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 139, No. Suppl_1 ( 2019-03-05)
    Abstract: Objective: To estimate the association of rural vs urban living in the United States (US) with incident cognitive impairment (ICI), and to assess confounding, mediation, and effect heterogeneity by demographic, social, behavioral, and clinical risk factors. Methods: REGARDS is a cohort of 30,239 adults aged 45+ in the 48 contiguous states. We analyzed 20,592 participants who at baseline (2003-2007) were cognitively intact with no history of stroke and had cognition assessed an average of 7.1 years later. We used Rural-Urban Commuting Area (RUCA) codes to classify participants as urban (n = 16,436), large city/town (n = 2,420), or small/isolated rural (n = 1,736) at baseline. We defined ICI as falling ≥1.5 SD below the mean on at least two of three cognitive tests administered during follow-up: word list learning, word list delayed recall, and animal naming. Using urban as the referent, we estimated odds ratios of ICI for rural and for large city/town. Results: ICI occurred in 1,291 participants (6.3%). Rural residents had 49% higher odds of ICI adjusted for confounding by demographics (Model 2 in Table, OR = 1.49 [95% CI: 1.19, 1.85]). After further adjusting for potential mediators (Models 3-6), odds of ICI remained 25% higher for rural vs urban (Model 6, OR = 1.25 [0.99, 1.56] ). In assessing effect heterogeneity, we found synergism of rural dwelling with black race, physical inactivity, and low self-rated health (all P 〈 0.1; see ORs in Table), but not for other ICI risk factors. We found no difference in ICI for large city/town vs urban (demographics-adjusted OR = 1.08 [0.88, 1.33]; fully adjusted OR = 0.95 [0.77, 1.18] ), and no effect heterogeneity of ICI risk factors by large city/town (all P 〉 0.2). Conclusion: Rural living is an important social determinant of cognitive health in the US. ICI was significantly more frequent among rural dwellers than urban dwellers, partly due to confounding or mediation by ICI risk factors. Odds of ICI were highest for rural dwelling combined with black race, physical inactivity, or low self-rated health.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.139.suppl_1.032
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1466401-X
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