In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 4 ( 2011-04), p. 952-959
Abstract:
This study aimed to determine, among older men, the risk and independent significant baseline prognostic factors for first-ever stroke and MI. Methods— We performed a prospective cohort study of 4382 community-dwelling older men (mean age, 75.4±4.2 years) with no history of stroke or MI. Baseline data comprised questionnaire responses, clinical measurements, and comorbidity. Results— After a median of 6 years (interquartile range, 5.2–7.2) of follow-up, the overall rate of stroke/MI was 2.61 (95% CI, 2.42–2.81) per 100 person-years. Among major traditional risk prediction variables, only age and smoking were significantly associated with stroke/MI. In our final multivariate model, the independent significant predictors of stroke/MI were age (HR for age older than 85, 3.18; 95% CI, 2.05–4.93), diastolic blood pressure 〈 70 mm Hg (Hazard ratio [HR], 1.45; 95% CI, 1.18–1.78), high-sensitivity C-reactive protein 〉 3 mg/L (HR, 1.29; 95% CI, 1.05–1.59), homocysteine 〉 15 umol/L (HR, 1.35; 95% CI, 1.09–1.67), waist-to-hip ratio 〉 1 (HR, 1.47; 95% CI, 1.20–1.18), and fair or poor self-reported health (HR, 1.52; 95% CI, 1.19–1.94). A new risk model incorporating these variables performed well compared with the Framingham risk equation (Harrell C of 0.660 versus C of 0.620; integrated discrimination improvement of 1.85%; z=4.95; P 〈 0.001; net reclassification index of 0.08; z=2.0; P =0.023). The model was used to develop an 8- point clinical risk score comprising the independent predictors of stroke/MI among this population. Conclusions— Traditional vascular risk factors did not optimally predict stroke/MI among this cohort of community-dwelling older men. We have constructed a new risk score that requires validation in other data sets.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/STROKEAHA.110.603480
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2011
detail.hit.zdb_id:
1467823-8
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