TY - JOUR
T1 - Predictors of incident stroke among individuals without coronary artery calcification
T2 - A pooled cohort analysis from the Multi-Ethnic Study of Atherosclerosis, Jackson Heart Study, and Framingham Heart Study
AU - Hussain, Aliza
AU - Johansen, Michelle C.
AU - Blaha, Michael J.
AU - Al-Mallah, Mouaz H.
AU - Cainzos-Achirica, Miguel
AU - Nambi, Vijay
AU - Rotter, Jerome I.
AU - Guo, Xiuqing
AU - Yao, Jie
AU - Rich, Stephen S.
AU - Patel, Jaideep
AU - McEvoy, John W.
AU - Nasir, Khurram
AU - Gottesman, Rebecca
AU - Blumenthal, Roger S.
AU - Ballantyne, Christie M.
AU - Virani, Salim S.
AU - Al Rifai, Mahmoud
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Introduction: The absence of coronary artery calcium (CAC = 0) is associated with low risk of stroke events; however, predictors of incident stroke among those with CAC = 0 are not known. Methods: Individual participant-level data were pooled from three prospective cohorts (Multi-Ethnic Study of Atherosclerosis, Jackson Heart Study, and Framingham Heart Study). Multivariable-adjusted Cox proportional hazards models were used to study the association between cardiovascular risk factors and incident adjudicated stroke among individuals with CAC = 0 who were free of clinical atherosclerotic cardiovascular disease at baseline. Results: Among 6180 participants (mean age 53 [SD 11] years, 62% women, and 44% White, 36% Black, and 20% other individuals), over a median (IQR) follow up of 15 (12–16) years, there were 122 strokes (95 ischemic, 27 hemorrhagic) with an overall unadjusted event rate of 2.0 per 1000 person-years. After multivariable adjustment, risk factors associated with overall stroke included (hazard ratio [95% CI]) systolic blood pressure (SBP): 1.19 (1.05–1.36) per 10-mmHg increase and carotid intima–media thickness (CIMT): 1.21 (1.04–1.42) per 0.1-mm increment. Current cigarette smoking: 2.68 (1.11–6.50), SBP: 1.23 (1.06–1.42) per 10-mmHg increase, and CIMT: 1.25 (1.04–1.49) per 0.1-mm increment were associated with ischemic stroke, whereas C-reactive protein was associated with hemorrhagic stroke risk (0.49, 0.25–0.93). Conclusion: In a large cohort of individuals with CAC = 0, the rate for incident stroke was low (2.0 per 1000-person years) and was associated with modifiable risk factors.
AB - Introduction: The absence of coronary artery calcium (CAC = 0) is associated with low risk of stroke events; however, predictors of incident stroke among those with CAC = 0 are not known. Methods: Individual participant-level data were pooled from three prospective cohorts (Multi-Ethnic Study of Atherosclerosis, Jackson Heart Study, and Framingham Heart Study). Multivariable-adjusted Cox proportional hazards models were used to study the association between cardiovascular risk factors and incident adjudicated stroke among individuals with CAC = 0 who were free of clinical atherosclerotic cardiovascular disease at baseline. Results: Among 6180 participants (mean age 53 [SD 11] years, 62% women, and 44% White, 36% Black, and 20% other individuals), over a median (IQR) follow up of 15 (12–16) years, there were 122 strokes (95 ischemic, 27 hemorrhagic) with an overall unadjusted event rate of 2.0 per 1000 person-years. After multivariable adjustment, risk factors associated with overall stroke included (hazard ratio [95% CI]) systolic blood pressure (SBP): 1.19 (1.05–1.36) per 10-mmHg increase and carotid intima–media thickness (CIMT): 1.21 (1.04–1.42) per 0.1-mm increment. Current cigarette smoking: 2.68 (1.11–6.50), SBP: 1.23 (1.06–1.42) per 10-mmHg increase, and CIMT: 1.25 (1.04–1.49) per 0.1-mm increment were associated with ischemic stroke, whereas C-reactive protein was associated with hemorrhagic stroke risk (0.49, 0.25–0.93). Conclusion: In a large cohort of individuals with CAC = 0, the rate for incident stroke was low (2.0 per 1000-person years) and was associated with modifiable risk factors.
KW - cardiovascular risk factors
KW - coronary artery calcium
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85203679547&partnerID=8YFLogxK
U2 - 10.1177/1358863X241270911
DO - 10.1177/1358863X241270911
M3 - Article
C2 - 39239865
AN - SCOPUS:85203679547
SN - 1358-863X
JO - Vascular Medicine
JF - Vascular Medicine
ER -
